Antibiotic prophylaxis for transurethral urological surgeries: Systematic review.
Antibiotic prophylaxis for transurethral urological surgeries: Systematic review.
复制标题
DOI：
10.4103/0974-7796.109993
复制
发表时间：
2013-04
期刊：
影响因子：
0.7
通讯作者：
Smith GH
中科院分区：
文献类型：
--
作者：
Alsaywid BS;Smith GH
内窥镜泌尿外科手术后使用抗生素预防来预防尿路感染和菌血症（败血症）是一个有争议的话题。文献证据表明，泌尿外科器械与尿路感染和菌血症发生率增加有关。本综述的目的是评估抗生素预防在降低经尿道泌尿外科手术患者尿路感染风险方面的有效性。我们选择了成人人群的所有随机对照试验，这些患者接受了各种不同类型的经尿道泌尿外科手术，包括膀胱镜检查、经尿道前列腺切除术和经尿道膀胱肿瘤切除术，并接受了预防性抗生素或安慰剂/不治疗。最初，确定并审查了 3000 多个参考文献；其中42项研究共7496名患者纳入最终分析。所有这些试验都在分析抗生素预防与安慰剂/不治疗，并且显着支持使用抗生素来减少所有结局，包括菌尿（RR 0.36，95% CI 0.29 至 0.46，P < 0.0001），检测到中度异质性（I2 48%），症状性尿路感染（RR 0.38，95% CI 0.28 至 0.46）。 检测到无显着异质性 (I2= 17%)、菌血症 (RR 0.43, 95% CI 0.23 至 0.82, P < 0.0001)、无明显异质性 (I2 = 0%) 以及发烧 ≥38.5 摄氏度 (RR 0.41, 95% CI 0.23 至 0.51, P < 0.0001)。 0.73，P = 0.003）；此外，没有明显的异质性（I2 = 0%）。然而，使用抗生素预防并不能降低低度体温（RR 0.82，95% CI 0.61至1.11，P = 0.20）或中度体温（RR 1.03，95% CI 0.71至1.48，P = 0.89）的发生率。对于术前尿液无菌的患者，预防性使用抗生素似乎是预防经尿道泌尿外科手术后尿路感染及其后遗症的有效干预措施。
The use of antibiotic prophylaxis to prevent urinary tract infection and bacteremia (sepsis) following endoscopic urologic procedures is a controversial topic. Evidence in the literature revealed that urological instrumentation is associated with increased incidence of urinary tract infection and bacteremia. The aim of this review is to evaluate the effectiveness of antibiotic prophylaxis in reducing the risk of urinary tract infection in patients who had transurethral urological surgeries. We have selected all RCTs of adult population who underwent all different types of transurethral urological surgery, including cystoscopy, transurethral resection of prostate and transurethral resection of bladder tumor, and received prophylactic antibiotics or placebo/no treatment. At first, more than 3000 references were identified and reviewed; of which 42 studies with a total of 7496 patients were included in the final analysis. All those trials were analyzing antibiotic prophylaxis versus placebo/no treatment, and they were significantly favoring antibiotic use in reducing all outcomes, including bacteriuria (RR 0.36, 95% CI 0.29 to 0.46, P < 0.0001) with moderate heterogeneity detected (I2 48%), symptomatic UTI (RR 0.38, 95% CI 0.28 to 0.51, P < 0.0001) with no significant heterogeneity was detected (I2= 17%), bacteremia (RR 0.43, 95% CI 0.23 to 0.82, P < 0.0001) with no noted heterogeneity (I2 = 0%), and fever ≥38.5 Celsius (RR 0.41, 95% CI 0.23 to 0.73, P = 0.003); also, there was no noted heterogeneity (I2 = 0%). However, using antibiotic prophylaxis did not reduce the incidence of low grade temperature (RR 0.82, 95% CI 0.61 to 1.11, P = 0.20) or in moderate grade temperature (RR 1.03, 95% CI 0.71 to 1.48, P = 0.89). Antibiotic prophylaxis appears to be an effective intervention in preventing urinary tract infections and its sequels following transurethral urological surgeries in patients with preoperative sterile urine.