Antibiotikaprofylax vid kirurgiska ingrepp - SBU

Table 4.12.7 Transurethral resection of the prostate (TURP).
Author
Year
Reference
Country
Study
design
Population
characteristics
Intervention
Method
Number individuals
Control
Number
individuals
Results
Withdrawal
Drop outs
Study quality
and relevance
Comments
Berry
2002
[1]
Australia
Metaanalysis
TURP
BU/UTI 32 RCT, 4 260 pts.
Sepsis 8 RCT 1 979 pts
I: Ab (n=2 346) C: No ab
(n=1 914)
BU/UTI
I: 213/2 346 (9.1%)
C: 497/1 914 (26%) sign
Sepsis
I: 9/1 229 (0.7%)
C: 33/750 (4.4%) sign
Not reported
High
Costa
1994
[41]
USA
RCT
Visal laser ablation of
prostate (VLAP). Catheter
for 2 days after VLAP
Results during first 14 days
I: Single dose lomefloxacin
400 mg oral (n=20)
I2: Same + 400 mg lomefloxacin
for 3 days (n=20)
C: No ab BU >10 000 cfu/mL
I1: 2 (10%)
I2: 1 (5%)
C: 10 (50%)
Moderate
Antibiotic prophylaxis
reduces the frequency of
post VLAP bacteriuria
Grabe
1987
[39]
Sweden
Systematic
review
Review 16 studies TURP.
Sterile urine
I: Ab one to several days
(n=846)
C: No ab
(n=790)
BU/UTI
I: 84/846 (9.9%)
C: 268/790 (33.9%) sign
Not reported
High
Qiang
2005
[2]
USA
Metaanalysis
TURP/Preoperative sterile
urine
I: Ab/2 383 (outcome 1)
Ab/839 (outcome 2)
C: No ab
(n=1 864)
(outcome 1)
No ab (n=766)
(outcome 2)
BU/UTI
I: 217/2383 (9.1%)
C: 492/1864 (26.4%)
RD=–0.17
Fever
I: 189/839 (22.5%)
C: 206/766 (26.9%)
RD=–0.11
Average 4%
High
Reduces additional ab
(–0.20). All regimens give
reduction. Short course
better than single dose
Wagenlehner
2005
[40]
Germany
RCT
TURP. Preoperative sterile
urine. Randomisation 2:2:1,
multicenter
Follow-up at 1 week, and
3–5 weeks
I1: Single dose levofloxacin
500 mg (n=151)
I2: Co-trimoxazol
320/1 600 mg (n=151)
C: TURP/
No ab (n=74)
BU/UTI
1 week
I1: 32/151(21.1%)
I2: 30/151 (19.9%)
C: 22/74 (29.7%)
3–5 weeks
I1: 25.9%
I2: 26.1%
C: 36.3%
6% High
Higher additional ab
in controls from 5.0
to 6.9 doses/individual
Increased risk of complications
in cases with
BU
ab = Antibiotic; BU = Bacteriuri; C = Control group; cfu = Colony forming units;
I = Intervention group; n = Number of patients; pts = Patients; RCT = Randomised
controlled trial; RD = Risk difference; TURP = Transurethral resection of the prostate;
UTI = Urinary tract infection; VLAP = Visually-guided laser ablation of the prostate
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