Proactive discontinuation of postoperative antibiotic prophylaxis after urethroplasty

• Published in: International journal of urology Vol. 29; no. 7; pp. 707 - 711
• Main Authors: Hanasaki, Takeshi, Kanematsu, Akihiro, Yamamoto, Shingo
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.07.2022
• Subjects: Antibiotics; Antimicrobial agents; Bacteriuria; Disease prevention; infection; Intravenous administration; Patients; Prophylaxis; Success; urethroplasty; Urinary tract; Urine; urethroplasty; infection; bacteriuria; antibiotics; prophylaxis
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.14878

Objective We aimed to examine the clinical significance of an antimicrobial administration protocol, in which postoperative prophylaxis was proactively discontinued. Methods We included 81 adult urethroplasties performed at our institution in the study. Preoperative bacteriuria was treated using an appropriate antimicrobial agent 2–5 days before surgery. All patients were treated with intravenous antimicrobial agents until postoperative day 2, and thereafter without prophylaxis. Antibiotics were resumed from the day before the urethrogram for urethral catheter removal, 2–3 weeks postoperatively. The relationships between pre‐ and postoperative positive urine culture and postoperative infectious complications, along with factors influencing surgical success rate were examined retrospectively. Results Of the 81 patients, 60 underwent anastomotic repair and 21 underwent substitution repair. Positive preoperative urine cultures were more frequent in patients having suprapubic cystostomy tube than in those without (P < 0.0001), but such a difference was not noted postoperatively between the two groups, and approximately half of the patients had a positive urine culture postoperatively. Wound infections and symptomatic urinary tract infections rates were 3.7% and 2.5%, respectively, similar to previous studies with longer prophylaxis, and no significant correlation was noted with pre‐ and postoperative positive urine culture, treated by this antibiotic protocol. The overall clinical and objective success rates were 96.3% and 79.0%, respectively, and no significant impact of pre‐ or postoperative positive urine culture was noted. The only significant parameter for objective success was patient age. Conclusion Perioperative management of urethroplasty is feasible using the antimicrobial protocol described in this study.