Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/37082
Title: Antimicrobial Prophylaxis in Transurethral Resection of the Prostate: Results of a Randomized Trial
Authors: BATEN, Evert 
Van der Aa, F.
GOETHUYS, Hans 
Slabbaert, K.
ARIJS, Ingrid 
VAN RENTERGHEM, Koenraad 
Issue Date: 2021
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Source: JOURNAL OF UROLOGY, 205 (6) , p. 1748 -1752
Abstract: Purpose: We sought to determine whether omitting antimicrobial prophylaxis is safe in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative catheter. Materials and Methods: We conducted a multicenter randomized controlled trial from September 17, 2017 until December 31, 2019 in 5 hospitals. Patients with pyuria (>100 white blood cells/ml) and a preoperative indwelling catheter were excluded. Postoperative fever was defined as a body temperature >= 38.3C. A noninferiority design was used with a 6% noninferiority margin and null hypothesis (H0) that the infection risk is at least 6% higher in the experimental (E) than in the control (C) group; H0: C (antimicrobial prophylaxis group) - E (no antimicrobial prophylaxis group) >=Delta (6% noninferiority margin). A multivariable, logistic regression was performed regarding posttransurethral resection of the prostate fever and antimicrobial prophylaxis with co-variates: (clot-)retention and operating time. The R Project (R) for statistical computing was used and a p value of 0.05 was considered as statistically significant. Results: Of the patients 474 were included for multivariable analysis and 211/ 474 (44.5%) received antimicrobial prophylaxis vs 263/474 (55.5%) patients without antimicrobial prophylaxis. Antibiotics were fluoroquinolones in 140/211 (66.4%), cephazolin in 58/211 (27.5%) and amikacin in 13/211 (6.2%) patients. Fever occurred in 9/211 (4.4%) patients with antimicrobial prophylaxis vs 13/263 (4.9%) without antimicrobial prophylaxis (p=0.8, risk difference 0.006 [95% CI -0.003-0.06, relative risk 1.16]). We were able to exclude a meaningful increase in harm associated with omitting antimicrobial prophylaxis (p=0.4; adjusted risk difference 0.016 [95% CI -0.02-0.05]). Conclusions: Our data demonstrate the safety of omitting antimicrobial prophylaxis in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative indwelling catheter.
Notes: Baten, E (corresponding author), AZ Diest UHasselt, Associatie Urol Hageland RZ Tienen, Kapellekensweg 10, Kessel Lo, Belgium.
Evert.baten@gmail.com
Keywords: transurethral resection of prostate;randomized controlled trial;fever;drug resistance;microbialantibiotic prophylaxis
Document URI: http://hdl.handle.net/1942/37082
ISSN: 0022-5347
e-ISSN: 1527-3792
DOI: 10.1097/JU.0000000000001638
ISI #: WOS:000760589000043
Rights: 2021 by American Urological Association Education and Research, Inc.
Category: A1
Type: Journal Contribution
Validations: ecoom 2023
Appears in Collections:Research publications

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