Veliev E I, Sokolov E A, Metelev A Yu, Aliev E N, Polyakova A S, Ivkin E V
Russian Medical Academy of Continuous Professional Education, Department of Urology and Surgical Andrology, Moscow, Russia.
S.P. Botkins State Clinical Hospital, Moscow, Russia.
Urologiia. 2024 Mar(1):35-40.
To evaluate the effect of antibacterial prophylaxis using oral fosfomycin during the removal of a urethral catheter after radical prostatectomy on the development of urinary tract infection, severity of leukocyturia and bacteriuria, as well as the severity of lower urinary tract symptoms.
A single-center, non-blind, prospective, randomized controlled trial was carried out. The main group included 40 patients, and the control group included 37 patients. In the group 1, patients received two doses of oral fosfomycin, 3 g, namely in the evening on the day of catheter removal (the first dose) and 48 hours after catheter removal (the second dose). In the group 2, patients did not receive any antibacterial prophylaxis after urethral catheter removal. The endpoints of the study were confirmed episodes of urinary tract infection within 1 month after removal of the urethral catheter, leukocyturia and bacteriuria in urinalysis/urine culture) and severity of the lower urinary tract symptoms assessed by IPSS questionnaire.
In the group 2, urinary tract infection was noted in 17.1%, while in the group 2 only in 2.6% of patients (p=0.032). Leukocyturia and bacteriuria were significantly less common in the group receiving antibacterial prophylaxis with fosfomycin (18.4% vs. 48.6%, respectively; p=0.006). Positive urine culture was observed in 7.9% vs. 25.7%, respectively (p=0.035). Four weeks after removal of the urethral catheter, the average IPSS score was significantly higher in the group 2 (13.2 vs. 9.5 points; p=0.002). There were no cases of allergic reaction and pseudomembranous colitis associated with C. difficile in both groups. Diarrhea cured with sorbents was noted in 2 patients (5.2%) in fosfomycin group.
Antibacterial prophylaxis using two oral doses of fosfomycin 3 g on the day of urethral catheter removal and 48 hours after catheter removal after radical prostatectomy appears to be an effective scheme that reduces the incidence of urinary tract infection and the severity of lower urinary tract symptoms, and is characterized by a minimal risk of adverse events. It is necessary to carried out further research and develop clear recommendations for antibacterial prevention in urological interventions requiring prolonged urethral catheterization.
评估根治性前列腺切除术后拔除尿道导管期间口服磷霉素进行抗菌预防对尿路感染的发生、白细胞尿和菌尿的严重程度以及下尿路症状严重程度的影响。
开展一项单中心、非盲、前瞻性、随机对照试验。主要组包括40例患者，对照组包括37例患者。在第1组中，患者接受两剂口服磷霉素，3克，即在拔除导管当天晚上（第一剂）和拔除导管后48小时（第二剂）。在第2组中，患者在拔除尿道导管后未接受任何抗菌预防。研究的终点是拔除尿道导管后1个月内确诊的尿路感染发作、尿液分析/尿培养中的白细胞尿和菌尿，以及通过国际前列腺症状评分（IPSS）问卷评估的下尿路症状严重程度。
在第2组中，17.1%的患者出现尿路感染，而在第1组中仅2.6%的患者出现尿路感染（p = 0.032）。接受磷霉素抗菌预防的组中白细胞尿和菌尿明显较少见（分别为18.4%对48.6%；p = 0.006）。尿培养阳性率分别为7.9%对25.7%（p = 0.035）。拔除尿道导管四周后，第2组的平均IPSS评分明显更高（13.2对9.5分；p = 0.002）。两组均未出现与艰难梭菌相关的过敏反应和伪膜性结肠炎病例。磷霉素组有2例患者（5.2%）出现用吸附剂治愈的腹泻。
根治性前列腺切除术后在拔除尿道导管当天和拔除导管后48小时口服两剂3克磷霉素进行抗菌预防似乎是一种有效的方案，可降低尿路感染的发生率和下尿路症状的严重程度，且不良事件风险极小。有必要开展进一步研究，并为需要长时间留置尿道导管的泌尿外科干预制定明确的抗菌预防建议。
