Berrino Pasquale Maria, Gatti Milo, Rotaru Valeria, Bianchi Lorenzo, Tumietto Fabio, Sora Elena, Schiavina Riccardo, Brunocilla Eugenio, Viale Pierluigi, Pea Federico
Division of Urology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy.
Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
Antibiotics (Basel). 2024 May 6;13(5):424. doi: 10.3390/antibiotics13050424.
This study aimed to assess the efficacy of a novel prophylactic scheme of fosfomycin trometamol in patients undergoing elective HoLEP (holmium laser enucleation of the prostate) or TURP (transurethral resection of the prostate) procedures for treating benign prostatic hyperplasia. Patients affected by benign prostatic hyperplasia and undergoing elective HoLEP or TURP procedures during the period February 2022-June 2023 were prospectively enrolled. Two 3 g oral fosfomycin trometamol doses 12 h apart were administered at 8.00 p.m. on day -1 (i.e., the day before HoLEP or TURP procedure) and at 8.00 a.m. on day 0 (i.e., the day of the surgical procedure). The following outcomes were assessed: prevalence of fever occurring in the first 48 h after surgical procedure; prevalence of urological complications occurring after the surgical procedure; prevalence of proven urinary tract infections (UTIs) and/or bloodstream infections (BSIs) at 14 days post-procedure; and prevalence of emergency department admission for UTI-related sepsis at 14 days post-procedure. Univariate analysis comparing patients with and without proven UTI, BSI, or emergency department admission at 14 days post-procedure was carried out. Overall, 96 patients (median age 70 years) undergoing HoLEP (82.3%) or TURP (17.7%) were prospectively included. Median (IQR) time of surgical procedure after the morning fosfomycin dose was 226.5 min (range 88.5-393.75 min). Fever in the post-surgical 48 h occurred in 3/96 patients (3.1%). Prevalence of proven UTI at 14 days was as low as 1.0% (1/96), whereas no patient had proven BSI or UTI-related sepsis requiring emergency department admission at 14 days. Our findings support the contention that a prophylactic scheme based on two doses of fosfomycin trometamol 12 h apart before surgical intervention may represent a valuable strategy for preventing infectious complications in urologic patients undergoing HoLEP or TURP. Larger definitive confirmatory studies are warranted.
本研究旨在评估一种新型的磷霉素氨丁三醇预防性给药方案对接受选择性钬激光前列腺剜除术（HoLEP）或经尿道前列腺切除术（TURP）治疗良性前列腺增生患者的疗效。对2022年2月至2023年6月期间受良性前列腺增生影响并接受选择性HoLEP或TURP手术的患者进行前瞻性纳入。在手术前一天晚上8点（即HoLEP或TURP手术前一天）和手术当天上午8点（即手术当天）分别给予两剂3g口服磷霉素氨丁三醇，间隔12小时。评估以下结果：手术后48小时内发热的发生率；手术后泌尿系统并发症的发生率；术后14天确诊的尿路感染（UTI）和/或血流感染（BSI）的发生率；以及术后14天因UTI相关脓毒症而急诊入院的发生率。对术后14天有或没有确诊UTI、BSI或急诊入院的患者进行单因素分析。总体而言，前瞻性纳入了96例接受HoLEP（82.3%）或TURP（17.7%）的患者（中位年龄70岁）。上午给予磷霉素后手术的中位（IQR）时间为226.5分钟（范围88.5 - 393.75分钟）。96例患者中有3例（3.1%）在术后48小时内发热。术后14天确诊UTI的发生率低至1.0%（1/96），而在术后14天没有患者确诊BSI或因UTI相关脓毒症需要急诊入院。我们的研究结果支持这样的观点，即在手术干预前间隔12小时给予两剂磷霉素氨丁三醇的预防性给药方案可能是预防接受HoLEP或TURP的泌尿外科患者感染性并发症的一种有价值的策略。需要进行更大规模的确证性研究。
