Can we avoid routine antimicrobial prophylaxis (AMP) before transurethral resection of the bladder tumor (TURB)?

Aim of the study: Evidences about utility of AMP in order to reduce infectious complications resulting from TURB are lacking. Objectives of this study are to determine the frequency of febrile infectious complications after TURB with and without AMP and to asses risk factors for postoperative infectious complications. Materials and methods: We retrospectively reviewed clinical data of all patients who underwent TURB in our institution between January 2011 and December 2016. Reviewing all clinical document produced during the in-stay periods we collected data about patient and tumor features. The end point was incidence of infections defined as a body temperature >37.5° sustained for at least 24h and elevation of serum inflammatory markers during postoperative stay. Results: In the period of the study a total of 829 consecutive TURBs were performed. 753 TURB/patients matched the inclusion criteria, 565 (75%) male and 188 women (25%). Median age was 72,5 years (IQR: 67–80). Median operative time was: 27.7 (IQR 15–35) minutes. Median Length of post-operative hospitalization was 3,23 days (IQR 2– 4). A total of 31 (4,16%) patients developed an infectious complication. 599 patients did not receive any AMP, 3,7% of patients in this group developed an infective complication. AMP was given to 154 patients and 7,14% of the patients in this group developed an infective complication. A significant correlation between use of AMP and incidence of infectious complications was found ( p:0,034). Preoperative urinocolture were negative for 664 (88,2%) patients, positive for 72 (9,5%) patients and not disposable for 17 (2,3%) patients. 7,5% of the patients with positive preoperative urinocolture developed an infectious complication versus the 3,6% of patients with negative urinocolture (p:0,0028). 158 patients presented BPH, 11 of them developed an infectious complication. BPH was correlated with higher risk of postoperative infectious ( p:0,0429). Discussion: To our knowledge this is the biggest series analyzing risk of infectious complications after TURB and the only study that provides a sub-group analysis according to presence of risk factors for post- operative infections. Given our result, the use of AMP before routine TURB seems to be unnecessary.