[Antibiotics in transurethral resection of the prostate in patients with low risk of infectious complications: randomized prospective comparative study].

Objectives: To compare the rate of infectious complications using 2 antibiotic schemes in prostatic transurethral resection of the prostate (TUR-P) of patients at low risk, in order to reduce the use of antibiotics in this kind of patients. Secondarily, try to weigh the influence of clinical background, intraoperative complications and postoperative outcome on the development of such complications.

Methods: A comparative, prospective, randomized, open study was designed including 95 patients with sterile urine without indwelling catheter, subjected to TUR-P during one year. Group 1 received cefazolin 1 gr. i.v. preoperative and every 8 hrs. during the first day (3 doses) followed by ciprofloxacin 250 mg. oral every 12 hrs until the catheter was removed (therapeutic dose). Group 2 received cefazolin 1 gr. i.v. preoperative and at 8 hrs postoperative (2 doses) followed by nitrofurantoin 100 mg. oral every night until the catheter was removed (prophylactic dose). Five patients were excluded after randomization (5.3%) and all the remainders completed follow up.

Results: Ninety patients are analyzed, 45 in each group. Both groups were well matched with regard to clinical background, surgical and postoperative parameters and complications. Fever (axillary temperature equal or over 37.5 degrees C) was present in 2% of Group 1 and 11% of Group 2 (p = 0.091). Postoperative early or late bacteriuria (colony count > 100,000 CFU/mL) was present in 2% of Group 1 and in 13% of Group 2 (p = 0.049). Postoperative urinary infection (bacteriuria + clinical infection) was present in 2% of Group 1 and in 16% of Group 2 (p = 0.026). A statistical association was found between fever and postoperative urinary infection in all patients (p = 0.029) and between purulent secretion during prostatic tissue cutting and fever in Group 2 (p = 0.01).

Conclusion: Patients in Group 1 (cefazolin-ciprofloxacin) presented significant less postoperative urinary infection than those in Group 2 (cefazolin-nitrofurantoin) represented by less postoperative bacteriuria frequency. This was possibly due to different antimicrobial activity and dosage of used drugs. Fever was statistically related to postoperative urinary infection.