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Marino F, Rossi F, Murri R, Sacco E. Antibiotic prophylaxis in urologic interventions: Who, when, where? Urologia 2024; 91:11-25. [PMID: 38288737 DOI: 10.1177/03915603231226265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Periprocedural prophylaxis in medicine encompasses the set of measures (physical, chemical, and pharmacological) used to reduce the risk of infection. Antibiotic prophylaxis (AP) refers to the administration of a short-term regimen of antibiotics shortly before a medical procedure to reduce the risk of infectious complications that can result from diagnostic and therapeutic interventions. The outspreading growth of multidrug-resistant bacterial species and changes in the bacterial local ecosystem have impeded the development of a unique scheme of AP in urology. OBJECTIVES To review the literature and current guidelines regarding AP for urological diagnostic and therapeutic procedures, and to define agents, timing, and occasions when administering pharmacological prophylaxis. Secondly, according to current literature, to open new scenarios where AP can be useful or useless. RESULTS Major gaps in evidence still exist in this field. AP appears useful in many invasive procedures and some sub-populations at risk of infectious complications. AP is not routinely recommended for urodynamic exams, diagnostic cystoscopy, and extracorporeal shock-wave lithotripsy. The available data regarding the use of AP during the transperineal prostate biopsy are still unclear; conversely, in the case of the transrectal approach AP is mandatory. AP is still considered the gold standard for the prevention of postoperative infective complications in the case of ureteroscopy, percutaneous nephrolithotomy, endoscopic resection of bladder tumor, endoscopic resection of the prostate, and prosthetic or major surgery. CONCLUSION The review highlights the complexity of determining the appropriate candidates for AP, emphasizing the importance of considering patient-specific factors such as comorbidities, immunocompetence, and the nature of the urologic intervention. The evidence suggests that a one-size-fits-all approach may not be suitable, and a tailored strategy based on the specific procedure and patient characteristics is essential.
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Affiliation(s)
- Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Francesco Rossi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
- Department of Urology, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Rita Murri
- Università Cattolica Del Sacro Cuore, Rome, Italy
- Department of Infectious Disease, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Emilio Sacco
- Università Cattolica Del Sacro Cuore, Rome, Italy
- Department of Urology, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
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Goubet AG, Rouanne M, Derosa L, Kroemer G, Zitvogel L. From mucosal infection to successful cancer immunotherapy. Nat Rev Urol 2023; 20:682-700. [PMID: 37433926 DOI: 10.1038/s41585-023-00784-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 07/13/2023]
Abstract
The clinical management of advanced malignancies of the upper and lower urinary tract has been revolutionized with the advent of immune checkpoint blockers (ICBs). ICBs reinstate or bolster pre-existing immune responses while creating new T cell specificities. Immunogenic cancers, which tend to benefit more from immunotherapy than cold tumours, harbour tumour-specific neoantigens, often associated with a high tumour mutational burden, as well as CD8+ T cell infiltrates and ectopic lymphoid structures. The identification of beneficial non-self tumour antigens and natural adjuvants is the focus of current investigation. Moreover, growing evidence suggests that urinary or intestinal commensals, BCG and uropathogenic Escherichia coli influence long-term responses in patients with kidney or bladder cancer treated with ICBs. Bacteria infecting urothelium could be a prominent target for T follicular helper cells and B cells, linking innate and cognate CD8+ memory responses. In the urinary tract, commensal flora differ between healthy and tumoural mucosae. Although antibiotics can affect the prognosis of urinary tract malignancies, bacteria can have a major influence on cancer immunosurveillance. Beyond their role as biomarkers, immune responses against uropathogenic commensals could be harnessed for the design of future immunoadjuvants that can be advantageously combined with ICBs.
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Affiliation(s)
- Anne-Gaëlle Goubet
- Gustave Roussy, Villejuif, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée - Ligue Nationale contre le Cancer, Villejuif, France
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
- AGORA Cancer Center, Lausanne, Switzerland
| | - Mathieu Rouanne
- Gustave Roussy, Villejuif, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée - Ligue Nationale contre le Cancer, Villejuif, France
- Department of Microbiology and Immunology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lisa Derosa
- Gustave Roussy, Villejuif, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée - Ligue Nationale contre le Cancer, Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, Kremlin-Bicetre, France
| | - Guido Kroemer
- Gustave Roussy, Villejuif, France
- Equipe labellisée par la Ligue contre le Cancer, Université de Paris Cité, Sorbonne Université, Institut Universitaire de France, Inserm U1138, Centre de Recherche des Cordeliers, Paris, France
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Comprehensive Cancer Institute, Villejuif, France
| | - Laurence Zitvogel
- Gustave Roussy, Villejuif, France.
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée - Ligue Nationale contre le Cancer, Villejuif, France.
- Faculté de Médecine, Université Paris-Saclay, Kremlin-Bicetre, France.
- Center of Clinical Investigations for In Situ Biotherapies of Cancer (BIOTHERIS) INSERM, CIC1428, Villejuif, France.
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Khawcharoenporn T, Kanoktipakorn P. Effectiveness of appropriate antibiotic prophylaxis for transurethral resection of the prostate in the era of antibiotic resistance. Infect Control Hosp Epidemiol 2021;:1-5. [PMID: 34261570 DOI: 10.1017/ice.2021.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The results of this study demonstrate the lower incidence of posttransurethral resection of the prostate (TURP) urinary tract infection (UTI) among patients receiving appropriate antibiotic prophylaxis (AAP) versus inappropriate antibiotic prophylaxis (27% vs 47%; P < .001). Preoperative urine culture procurement and APP are critical for post-TURP UTI prevention in the era of antibiotic resistance.
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Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, Eckert LO, Geerlings SE, Köves B, Hooton TM, Juthani-Mehta M, Knight SL, Saint S, Schaeffer AJ, Trautner B, Wullt B, Siemieniuk R. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis 2020; 68:e83-e110. [PMID: 30895288 DOI: 10.1093/cid/ciy1121] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/27/2018] [Indexed: 12/22/2022] Open
Abstract
Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.
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Affiliation(s)
- Lindsay E Nicolle
- Department of Internal Medicine, School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kalpana Gupta
- Division of Infectious Diseases, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, West Roxbury, Massachusetts
| | | | - Richard Colgan
- Department of Family and Community Medicine, University of Maryland, Baltimore
| | - Gregory P DeMuri
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Dimitri Drekonja
- Division of Infectious Diseases, University of Minnesota, Minneapolis
| | - Linda O Eckert
- Department of Obstetrics and Gynecology and Department of Global Health, University of Washington, Seattle
| | - Suzanne E Geerlings
- Department of Internal Medicine, Amsterdam University Medical Center, The Netherlands
| | - Béla Köves
- Department of Urology, South Pest Teaching Hospital, Budapest, Hungary
| | - Thomas M Hooton
- Division of Infectious Diseases, University of Miami, Florida
| | | | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Sanjay Saint
- Department of Internal Medicine, Veterans Affairs Ann Arbor and University of Michigan, Ann Arbor
| | | | - Barbara Trautner
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Bjorn Wullt
- Division of Microbiology, Immunology and Glycobiology, Lund, Sweden
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Torrance HD, Pearse RM, O’dwyer MJ. Does major surgery induce immune suppression and increase the risk of postoperative infection? Curr Opin Anaesthesiol 2016; 29:376-83. [DOI: 10.1097/aco.0000000000000331] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Gasser TC, Madsen PO. Timing, dosing and duration of antimicrobial prophylaxis in urology: a study in guinea pigs with special reference to high-risk conditions. Infection 1993; 21:49-53. [PMID: 8449583 DOI: 10.1007/bf01739315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A study in guinea pigs was performed to investigate the importance of timing, dosage and duration of antimicrobial prophylaxis in urologic surgery. To simulate high-risk conditions, in one group a foreign body was implanted subcutaneously. The prostate and one kidney were cauterized and bacteremia was induced by intravenous injection of an Escherichia coli suspension. Various ciprofloxacin regimens were tested. The results indicate that antimicrobial prophylaxis is beneficial only if administered before or shortly after surgery. Full therapeutic dosage may not be necessary for prophylactic efficacy. Single-dose prophylaxis was as effective as multiple doses. Foreign body infection could be prevented by single-dose prophylaxis.
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Affiliation(s)
- T C Gasser
- Urologische Klinik, Kantonsspital Basel, Switzerland
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Choutet P, Besnier J. Situations à risque d'endocardite infectieuse. Med Mal Infect 1992. [DOI: 10.1016/s0399-077x(05)80531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
A series of 140 patients, undergoing various types of urological endoscopic procedures, was divided into 2 equal, parallel, randomised groups. The first group of 70 patients, undergoing lower urinary tract surgery, was randomised, half to receive norfloxacin prophylaxis and half no antibiotic cover; the other 70 patients, undergoing percutaneous renal surgery, were randomised, half to receive norfloxacin and half cefuroxime. It was found that 26% of patients not receiving antibiotic prophylaxis and 11% on cefuroxime prophylaxis developed post-operative bacteriuria, with a high incidence of urinary tract infection (UTI). Only 1 patient of 70 on norfloxacin prophylaxis developed post-operative bacteriuria, which quickly responded to prolongation of norfloxacin therapy. Prior to surgery, 10% of all patients were found to have previously undetected bacteriuria. This group was at high risk of developing post-operative infection. Norfloxacin effectively prevented post-operative bacteriuria and urinary tract infection in these patients. This study suggests that norfloxacin is a safe and effective prophylactic antibiotic in all forms of urological endoscopic procedures.
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Affiliation(s)
- C L Cutajar
- Department of Urology, St Luke's Hospital, G'Mangia, Malta
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Gasser TC, Madsen PO. Antimicrobial Prophylaxis in Urology: Timing, Dosing, and Duration Studies with special reference to High-risk conditions. Antimicrobial Prophylaxis in Urology with special reference to the new Quinolones. Heidelberg: Steinkopff; 1992. pp. 69-76. [DOI: 10.1007/978-3-642-85422-4_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
An increasing incidence of bacterial endocarditis has been observed since the beginning of the last decade. An explanation for this fact is the expansion of diagnostic and therapeutic procedures in diverse medical disciplines. In a clinical study performed on 49 consecutive patients undergoing extracorporeal shock wave lithotripsy a 14.3% rate of bacteremia was detected during treatment. The bacterial spectrum consisted of gram-positive cocci, gram-negative cocci, Bacteroides capillosus and Proteus mirabilis. In principle, these results do not call for an antibiotic prophylaxis. Nevertheless, according to the recommendations of the American Heart Association and the Deutsche Gesellschaft für Herz- und Kreislaufforschung, patients with a cardiac risk predisposing to bacterial endocarditis must receive perioperative antibiotic prophylaxis.
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Affiliation(s)
- V G Müller-Mattheis
- Department of Urology, Heinrich-Heine-University of Düsseldorf Medical School, Federal Republic of Germany
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Affiliation(s)
- M E Gombert
- Department of Medicine, State University of New York, Health Science Center, Brooklyn
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Shearman CP, Silverman SH, Johnson M, Young CH, Farrar DJ, Keighley MR, Burdon DW. Single dose, oral antibiotic cover for transurethral prostatectomy. Br J Urol 1988; 62:434-8. [PMID: 3061557 DOI: 10.1111/j.1464-410x.1988.tb04391.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A double-blind, randomised, placebo-controlled study was carried out to determine the incidence and significance of bacteriuria in 110 patients undergoing transurethral resection of the prostate (TURP) and to assess the effect of a single pre-operative dose of Ciprofloxacin, a 4-quinolone antibiotic. Fifteen (68%) of the 22 patients in the placebo group with a positive post-operative urine culture subsequently developed a clinically apparent urinary tract infection (UTI) or received antibiotics in view of a positive urine culture. Adequate prostatic concentrations of Ciprofloxacin were achieved in all who received the drug. A significant reduction in the number of positive post-operative urine cultures and urinary tract infections requiring antibiotic therapy was achieved in this group. Six patients (5.5%) developed clinical evidence of septicaemia, 5 of whom were in the placebo group. No organisms resistant to Ciprofloxacin were encountered. Prior to surgery, 19% of all patients were found to have previously unsuspected bacteriuria. Ciprofloxacin tended to reduce the chances of this group developing a UTI or requiring antibiotics. Further, there was a highly significant reduction in post-operative infective complications in those with sterile urine at the time of resection who had received the drug. This study suggests that antibiotic cover for TURP is of clinical benefit. Ciprofloxacin may prove suited to this purpose, although further experience with the drug is still required.
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Affiliation(s)
- C P Shearman
- Department of Urology, Selly Oak Hospital, Birmingham
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Charton M, Vallancien G, Veillon B, Brisset JM. Antibiotic prophylaxis of urinary tract infection after transurethral resection of the prostate: a randomized study. J Urol 1987; 138:87-9. [PMID: 3599226 DOI: 10.1016/s0022-5347(17)43000-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Transurethral resection of the prostate is associated with a major risk of postoperative infection. To evaluate the clinical and bacteriological efficacy of antibiotic prophylaxis with a single dose of netilmicin sulfate, we conducted a randomized study in 100 patients with sterile preoperative urine undergoing transurethral resection of the prostate. Of these patients 95 were evaluated: 47 were randomized to the control group and received an intramuscular injection of 1.5 ml. of a 0.9 per cent solution of sodium chloride 1 hour preoperatively and 48 were given an intramuscular injection of 150 mg. netilmicin sulfate in a volume of 1.5 ml. 1 hour preoperatively. Of the patients 16 in the control group (34 per cent) and only 1 in the treated group (2 per cent) had bacteriuria (greater than 10(5) bacteria per ml.) (p less than 0.001). This difference also was significant 2 and 5 days postoperatively (p less than 0.05 and p less than 0.001, respectively). One patient in the control group had bacteremia compared to none in the treated group. Clinical signs of infection were less common in the treated group. Sensitivity studies revealed that all of the organisms tested were sensitive to netilmicin sulfate. High concentrations of netilmicin sulfate were found in the urine collected at operation (162 +/- 112 micrograms per ml. urine).
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Grabe M. Re: Short-Term Prophylactic Antibiotics in Patients Undergoing Prostatectomy: Report of a Double-Blind Randomized Trial with 2 Intravenous Doses of Cefotaxime, by P. Prokocimer, M. Quazza, C. Gibert, J. E. Lemoine, M. L. Joly, B. Dureuil, A. Moulonguet, C. Manuel and J. M. Desmonts, J. Urol., 135: 60–64, 1986. J Urol 1987. [DOI: 10.1016/s0022-5347(17)44004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Magnus Grabe
- Department of Urology University of Lund Malmö General Hospital S-214 01 Malmö, Sweden
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