Lawson Keith A, Rudzinski Jan K, Vicas Ingrid, Carlson Kevin V
Southern Alberta Institute of Urology, Division of Urology, Department of Surgery, University of Calgary, Calgary, AB;
Can Urol Assoc J. 2013 Jul-Aug;7(7-8):E530-6. doi: 10.5489/cuaj.205.
While antibiotic prophylaxis is recommended to all patients undergoing transurethral resection of prostate (TURP), little data exist regarding prescribing patterns of urologists prior to this procedure. Here, we sought to determine real-world antibiotic prophylaxis prescribing patterns at a high volume Canadian institution and determine compliance rates to recommendations put forth by the American Urological Association's (AUA) Best Practice Statement (BPS) on antimicrobial prophylaxis.
A retrospective chart review of 488 patients undergoing TURP was conducted. Electronic medical records were reviewed to determine antibiotics prescribed 3 hours preoperatively and 24 hours postoperatively. For patients without a catheter, compliance was defined as those receiving an antibiotic prior to TURP. In patients with an indwelling catheter, compliance was defined as those receiving antibiotics from two different classes prior to surgery.
Overall, a total of 30 antibiotic regimens were utilized. The most common single antibiotic regimens prescribed were ciprofloxacin (32%), cefazolin (25%) and gentamicin (3%). In those patients with indwelling Foley catheters prior to TURP, a significant increase in gentamicin, as well as combination antibiotic regimens, was noted. The compliance rate with the AUA BPS in patients without a preoperative catheter was 81%, while the compliance rate for patients with an indwelling catheter prior to TURP was 37%.
Collectively, our results demonstrate that prescribing patterns vary significantly prior to TURP, with compliance to AUA BPS being lower than anticipated. Overall, these results support educational efforts in this area, and the development of Canadian recommendations to improve uptake by practicing urologists.
虽然建议对所有接受经尿道前列腺切除术（TURP）的患者进行抗生素预防，但关于泌尿外科医生在此手术前的处方模式的数据很少。在此，我们试图确定一家加拿大大型机构的实际抗生素预防处方模式，并确定对美国泌尿外科学会（AUA）关于抗菌预防的最佳实践声明（BPS）所提出建议的依从率。
对488例接受TURP的患者进行回顾性病历审查。审查电子病历以确定术前3小时和术后24小时开具的抗生素。对于没有导尿管的患者，依从性定义为在TURP前接受抗生素治疗的患者。对于留置导尿管的患者，依从性定义为在手术前接受两种不同类别的抗生素治疗的患者。
总体而言，共使用了30种抗生素方案。最常用的单一抗生素方案是环丙沙星（32%）、头孢唑林（25%）和庆大霉素（3%）。在TURP前留置Foley导尿管的患者中，庆大霉素以及联合抗生素方案的使用显著增加。术前没有导尿管的患者对AUA BPS的依从率为81%，而TURP前留置导尿管的患者的依从率为37%。
总体而言，我们的结果表明，TURP前的处方模式差异很大，对AUA BPS的依从性低于预期。总体而言，这些结果支持在该领域开展教育工作，并制定加拿大的建议以提高执业泌尿外科医生的采纳率。
