University of California San Diego, San Diego, California.
University of Arizona, Tucson, Arizona.
J Urol. 2022 Jul;208(1):128-134. doi: 10.1097/JU.0000000000002487. Epub 2022 Feb 25.
There are no established guidelines regarding management of antibiotics for patients specifically undergoing urethral reconstruction. Our aim was to minimize antibiotic use by following a standardized protocol in the pre-, peri- and postoperative setting, and adhere to American Urological Association antibiotic guidelines. We hypothesized that prolonged suppressive antibiotics post-urethroplasty does not prevent urinary tract infection and/or wound infection rates.
We prospectively treated 900 patients undergoing urethroplasty or perineal urethrostomy at 11 centers over 2 years. The first-year cohort A received prolonged postoperative antibiotics. Year 2, cohort B, did not receive prolonged antibiotics. A standardized protocol following the American Urological Association guidelines for perioperative antibiotics was used. The 30-day postoperative infectious complications were determined. We used chi-square analysis to compare the cohorts, and multivariate logistic regression to identify risk factors.
The mean age of participants in both cohorts was 49.7 years old and the average stricture length was 4.09 cm. Overall, the rate of postoperative urinary tract infection and wound infection within 30 days was 5.1% (6.7% in phase 1 vs 3.9% in phase 2, p=0.064) and 3.9% (4.1% in phase 1 vs 3.7% in phase 2, p=0.772), respectively. Multivariate logistic regression analysis of patient characteristics and operative factors did not reveal any factors predictive of postoperative infections.
The use of a standardized protocol minimized antibiotic use and demonstrated no benefit to prolonged antibiotic use. There were no identifiable risk factors when considering surgical characteristics. Given the concern of antibiotic over-prescription, we do not recommend prolonged antibiotic use after urethral reconstruction.
目前尚无针对特定行尿道重建术患者的抗生素管理指南。我们的目的是通过遵循标准化方案来减少抗生素的使用，该方案适用于术前、术中和术后阶段，并遵循美国泌尿外科学会（American Urological Association，AUA）的抗生素使用指南。我们假设延长尿道成形术后的抗生素抑制治疗并不能降低尿路感染和/或伤口感染的发生率。
我们前瞻性地治疗了 11 个中心的 900 例接受尿道成形术或会阴尿道吻合术的患者，时间跨度为 2 年。第一年的队列 A 接受了延长术后的抗生素治疗，第二年的队列 B 未接受延长的抗生素治疗。使用了遵循 AUA 围手术期抗生素使用指南的标准化方案。确定了术后 30 天的感染性并发症。我们使用卡方检验比较了两个队列，并进行了多变量逻辑回归分析以确定危险因素。
两个队列的参与者平均年龄为 49.7 岁，平均狭窄长度为 4.09cm。总体而言，术后 30 天内尿路感染和伤口感染的发生率分别为 5.1%（第 1 阶段为 6.7%，第 2 阶段为 3.9%，p=0.064）和 3.9%（第 1 阶段为 4.1%，第 2 阶段为 3.7%，p=0.772）。对患者特征和手术因素的多变量逻辑回归分析并未发现任何预测术后感染的因素。
使用标准化方案可最大程度地减少抗生素的使用，且延长抗生素使用并未带来获益。在考虑手术特征时，没有发现可识别的危险因素。鉴于对抗生素过度处方的担忧，我们不建议在尿道重建术后延长抗生素的使用。
