Antimicrobial Prophylaxis for Postoperative Urinary Tract Infections in Transurethral Resection of Bladder Tumors: A Systematic Review and Meta-analysis. Letter

The correct use of antimicrobial drugs represents a major strategy to slow down or avoid the development of antimicrobial resistance.1 Given the high incidence of bladder cancer, transurethral resection of the bladder (TURB) is one of the most common urological procedures.2 Nowadays, many urologists give 1 or more doses of antimicrobial drugs as antimicrobial prophylaxis (AMP) to patients who undergo TURB. This practice is probably based on common habits but remarkably, as stated by Bausch et al in their recent review,3 there is an absence of evidence in the literature demonstrating that using AMP before routine TURB reduces the risks of infection complications.4 So far, in the age of evidence-based medicine, the study of Bausch et al importantly underlines the need for better quality evidence in sustaining or not the very common practice of the use of AMP for patients who undergo TURB. Interestingly enough, the answer to the question, “Does AMP reduce the rate of postoperative symptomatic urinary tract infection in patients undergoing TURB?” could be negative. It is a matter of fact that low quality evidence sustaining safety of TURB without using AMP exists. In our department, according to a nearly 11-year internal protocol, almost all patients with negative urine culture who undergo routine TURB do not receive any AMP regardless of the dimension of the tumor or the burden of patient comorbidity. With the purpose to assess results of this practice, we retrospectively reviewed all clinical files connected to hospitalization and the following first month after discharge of all patients who underwent TURB at our institution be- tween January 2011 and December 2013. We identified 223 patients who underwent TURB without AMP. In this population, only 6 (2.7%) patients developed postoperative infection compli- cations and no cases of sepsis were reported. According to these results we concluded that AMP should not be routinely used prior to TURB.5 We are well aware that many local factors could influence the risks of postoperative infectious complications and could limit the generalizations of our results. Furthermore, a randomized controlled trial would produce better evidence. However, despite limitations, we recommend consideration of our experience because avoiding the use of AMP prior to routine TURB even in a part of patients would spare thousands of doses of antibiotics every day. In the era of antimicrobial resistance, good use of antimicrobial drugs counts; and even small acts, like avoiding antimicrobial prophylaxis if not necessary, matter.