Bootsma A M Jikke, Laguna Pes M Pilar, Geerlings Suzanne E, Goossens Astrid
Department of Urology, Academic Medical Center, University of Amsterdam, The Netherlands.
Eur Urol. 2008 Dec;54(6):1270-86. doi: 10.1016/j.eururo.2008.03.033. Epub 2008 Mar 24.
Antibiotic prophylaxis is used to minimize infectious complications resulting from interventions. Side-effects and development of microbial resistance patterns are risks of the use of antibiotics. Therefore, the use should be well considered and based on high levels of evidence. In this review, all available evidence on the use of antibiotic prophylaxis in urology is gathered, assessed, and presented in order to make choices in the use of antibiotic prophylaxis on the best evidence currently available.
A systematic literature review was conducted, searching Medline, Embase (1980-2006), the Cochrane Library, and reference lists for relevant studies. All selected articles were reviewed independently by two, and, in case of discordance, three, reviewers.
Only the transurethral resection of prostate (TURP) and prostate biopsy are well studied and have a high and moderate to high level of evidence in favour of using antibiotic prophylaxis. Other urologic interventions are not well studied. The moderate to low evidence suggests no need for antibiotic prophylaxis in cystoscopy, urodynamic investigation, transurethral resection of bladder tumor, and extracorporeal shock-wave lithotripsy, whereas for therapeutic ureterorenoscopy and percutaneous nephrolithotomy, the low evidence favours the use of antibiotic prophylaxis. Urologic open and laparoscopic interventions were classified according to surgical wound classification, since no studies were identified. Antibiotic prophylaxis is not advised in clean surgery, but is advised in clean-contaminated and prosthetic surgery.
Except for the TURP and prostate biopsy, there is a lack of well-performed studies investigating the need for antibiotic prophylaxis in urologic interventions.
抗生素预防用于将干预导致的感染性并发症降至最低。抗生素的副作用和微生物耐药模式的发展是使用抗生素的风险。因此，抗生素的使用应经过充分考虑并基于高水平的证据。在本综述中，收集、评估并呈现了所有关于泌尿外科抗生素预防使用的现有证据，以便根据目前可得的最佳证据在抗生素预防使用方面做出选择。
进行了一项系统的文献综述，检索了Medline、Embase（1980 - 2006年）、Cochrane图书馆以及相关研究的参考文献列表。所有选定的文章由两名评审员独立评审，如有分歧则由三名评审员评审。
仅前列腺经尿道切除术（TURP）和前列腺活检得到了充分研究，并有高等级以及中等到高等级的证据支持使用抗生素预防。其他泌尿外科干预措施研究不足。中等到低等级的证据表明，在膀胱镜检查、尿动力学检查、膀胱肿瘤经尿道切除术和体外冲击波碎石术中无需使用抗生素预防，而对于治疗性输尿管肾镜检查和经皮肾镜取石术，低等级证据支持使用抗生素预防。由于未检索到相关研究，泌尿外科开放手术和腹腔镜手术根据手术切口分类进行了分类。清洁手术不建议使用抗生素预防，但清洁 - 污染手术和假体植入手术建议使用。
除了TURP和前列腺活检外，缺乏关于泌尿外科干预措施中抗生素预防必要性的高质量研究。
