The Risk Factors of Urinary Tract Infection After Transurethral Resection of Bladder Tumors - Beyond the Abstract

The risk of postoperative urinary tract infections (UTIs) after transurethral resection of bladder tumor (TURBT) is a highly controversial topic. The American Urological Association (AUA) and Japanese Urological Association (JUA) guidelines recommend the use of AMP for TURBT for all cases.1 However, JUA guidelines also note that it is not necessary for low-risk cases of UTIs.2 The European Association of Urology (EAU) guidelines note that AMP is not necessary for TURBT except patients who have a risk of UTIs and have large tumors requiring a prolonged operation time or necrotic tumors. Although all guidelines describe the general risk factors of infection for urological surgeries, there are few references about the risk factors of postoperative UTIs after TURBT.3 To evaluate the necessity of AMP and to detect the risk of UTIs, we examined the perioperative clinical factors.

687 patients who underwent TURBT between 2006 and 2017 at Hiroshima Prefectural Hospital were examined retrospectively. We defined the postoperative UTIs as febrile UTIs (≥38℃). The AMP for the TURBT that we used was mostly cephalosporin generation 1. The association between the perioperative clinical/pathological factors and postoperative UTIs was assessed by logistic regression retrospectively.

21 patients (3.1%) suffered from postoperative UTIs, and almost all of them were successfully treated with the immediate administration of antibiotics. Univariate analysis showed that past pelvic radiotherapy (p=0.024, odds ratio (OR): 6.00), tumor size (≥2cm) (p=0.008, OR: 3.38), age (≥75 years) (p=0.036, OR: 2.65), preoperative hospital stay (≥5 days) (p=0.017, OR: 3.76), asymptomatic pyuria (p=0.038, OR: 2.54) and bacteriuria (p=0.044, OR: 2.97) were all associated with postoperative UTIs. 

The evaluation of preoperative risks is necessary for appropriate use of AMP for TURBT. We demonstrated that AMP was effective for patients who underwent TURBT, and may not always be necessary for patients with low/intermediate risk of infection. However, it should be necessary for patients with the risk factors, such as the history of pelvic radiotherapy, high age, longer preoperative hospital stay and a certain tumor size that are major risk factors for postoperative UTIs of TURBT. 


Written by: Yuki Kohada, MD, Akihiro Goriki, MD, PhD, Kazuma Yukihiro, Shinya Ohara, MD and Mitsuru Kajiwara, MD, PhD, Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan

References:
1. Wolf JS, Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ (2008) Urologic surgery antimicrobial prophylaxis best practice policy panel: best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol 179:1379–90, 
2. Yamamoto S, Shigemura K, Kiyota H, et al (2016) Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition. Int J Urol 23:814-824
3. Grabe M, Bjerklund-Johansen TE, Botto H, et al (2013) Guidelines on Urological infections. https://uroweb.org/wp-content/uploads/18_Urological-infections_LR.pdf

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