Prophylactic antibiotic use in transurethral prostatic resection: a meta-analysis.

PURPOSE: We reviewed the efficacy of antibiotic prophylaxis in men undergoing transurethral prostatic resection, a clean contaminated procedure.
MATERIALS AND METHODS: We systematically reviewed randomized controlled trials of antibiotic prophylaxis for transurethral prostatic resection with a meta-analysis of the results. We identified 32 randomized controlled trials with 4,260 participants examining the postoperative bacteriuria incidence. An 8-trial subset with 1,979 participants examined postoperative septicemia occurrence.
RESULTS: Prophylactic antibiotic use in patients at low risk undergoing transurethral prostatic resection significantly decreased bacteriuria and clinical septicemia incidence. The bacteriuria incidence decreased from 26% to 9.1% (relative risk reduction 65%, 95% confidence interval -56 to -73). The clinical septicemia incidence decreased from 4.4% to 0.7% (relative risk reduction 77%, 95% confidence interval -55 to -88). Effective antibiotic classes included quinolones, cephalosporins, co-trimoxazole and aminoglycosides. Treatment protocols of any duration were effective. Subgroup analysis of cephalosporin based trials indicated that short treatment protocols appeared more effective than single dose protocols. Based on these results if 1,000 patients with sterile urine undergoing transurethral prostatic resection were given prophylactic antibiotics, bacteriuria would be avoided in 175, while septicemia would be prevented in 9 to 20.
CONCLUSIONS: Antibiotic prophylaxis significantly decreases the incidence of bacteriuria and clinical septicemia in men with preoperative sterile urine undergoing transurethral prostatic resection. A significant decrease in bacteriuria incidence can be achieved with a range of antibiotic agents, including quinolones, cephalosporins and co-trimoxazole. Short course antibiotic protocols may be more effective than single dose regimens.