Abstract: PD05-10
Sources of Funding: University of Rochester Department of Urology

Introduction

In an effort to reduce the incidence of symptomatic urinary tract infections (UTI) after urinary catheter removal after radical prostatectomy, many urologists administer prophylactic antibiotics. Currently, there are no consensus recommendations on this subject. Our objective was to determine whether antibiotic prophylaxis at urinary catheter removal after radical prostatectomy reduces the incidence of clinical UTIs. A secondary objective was to determine if prophylactic antibiotics increase in the incidence of Clostridium difficile (C. diff) infection.

Methods

Patients undergoing radical prostatectomy were enrolled (n=175) in an IRB approved prospective randomized controlled clinical trial. 4 patients were excluded for postoperative complications and 4 withdrew. The treatment group (n=83) was given ciprofloxacin the evening prior to and morning of catheter removal. The control group (n=84) received no antibiotics. All patients received up to 24 hours of routine peri-operative antibiotics. Catheters were removed at 7-10 days after surgery. Urine cultures (UC) were obtained preoperatively, at catheter removal, 3-12 months postoperatively and with development of any UTI symptoms. Clinical UTI was defined as positive UC with at least one organism >100,000 cfu/ml with at least 1 UTI symptom/sign. Statistical analyses were performed with two-sample T test for continuous variables, and Pearson&[prime]s chi-square or Fisher&[prime]s exact test for categorical values. The Jennison and Rurnbull method was used to determine futility.

Results

There was no significant difference in patient characteristics, perioperative data, post-operative readmissions or complications. There was no significant difference in the incidence of UTI: 5 (6.02%) in the antibiotic group and 5 (5.95%) in the control group (p=1). There was no significant difference in the incidence of C. diff infections between the two groups: 0 (0%) in the antibiotic group and 3 (3.57%) in the control group (p=0.24). There were no significant differences in postoperative complications or readmissions. Enrollment was discontinued after Interim analysis revealed a futility index of 98.22%.

Conclusions

This prospective randomized controlled trial provides evidence that antibiotic prophylaxis at the time of urinary catheter removal after radical prostatectomy does not reduce the incidence of clinical UTIs. We also did not find any association between the incidence of C. diff infection and administration prophylactic antibiotics.

Funding

University of Rochester Department of Urology