Do we really need systematic use of antimicrobial prophylaxis before transurethral resection of bladder tumor?

Aim of the Study: Aim of antimicrobial prophylaxis (AMP) is the prevention of infective complications resulting from diagnostic and therapeutic procedures. The Transurethral Resection of the Bladder (TURB) is a very common endoscopic surgery performed almost in all urological departments. Often an antibiotic prophylaxis is given to the patients that underwent TURB but this practice is not based on good quality evidences. Aim of this study is to report incidence of clinically relevant peri-operative infectious complications after TURBT without any antibiotic prophylaxis. Materials and Methods: We recruited all patients (pts) who underwent TURBT between 2011 and 2013 in our tertiary referral hospital. Data about preoperative urine culture, general health conditions, surgical procedure (duration and tumor features) and postoperative hospitalization until removal of the bladder catheter have been collected. Fever was defined as temperature >37.5 C for at least a whole day. Urosepsis was defined according to 2017 EAUguidelines on urological infections. Results: In the period of the study 223 pts underwent TURBT without any antibiotic prophylaxis. None of the 223 patients received a single dose of antibiotic drugs during the day of the surgery. Median age was 70,3 years; median duration of the post-operative hospitalization was 3 days. 8 pts had immunodeficiency (3.58%), 43 pts had diabetes (19.28%) and a total of 24 pts (10.76%) received peri-operative antibiotic therapy. Among them 16 had antibiotic treatment due to positive preoperative urine culture and all of them repeated cultural examination without evidence of persistent bacteriuria. For this reason they all underwent surgery without any antibiotic prophylaxis. Other 8 pts received antibiotic therapy during postoperative hospitalization, 6 because fever and 2 because of surgeon decision. For 51 pts resection lasted more than 30 minutes and fever appeared only in 2 of them (4%). No cases of urosepsis were reported. Discussion: The most important finding of this analysis is that infective complications after TURB without any antibiotic prophylaxis occurred in the 2,7% of the patients and no case of sepsis and septic