Antibiotic prophylaxis in transurethral resection of bladder tumours: study protocol for a systematic review and meta-analysis

Kathrin Bausch,Linda Maria Stamm,Sarah Ursula Sutter,Christian Appenzeller-Herzog,Hannah Ewald,Jan Adam Roth,Soheila Aghlmandi,Andreas F Widmer,Hans-Helge Seifert

doi:10.1186/s13643-020-01353-2

Abstract

BackgroundThe necessity of antibiotic prophylaxis for postoperative urinary tract infections (UTIs) after transurethral resection of bladder tumours is controversial. This potentially leads to the overuse of antibiotic prophylaxis and rising antimicrobial resistance rates. The objective of this systematic review and meta-analysis is to compare the impact of different antimicrobial prophylaxis schemes versus placebo on the prevention of postoperative UTI and asymptomatic bacteriuria.MethodsWe designed and registered a study protocol for a systematic review and meta-analysis of randomized controlled trials and non-randomized (e.g. cohort, case-control) studies examining any form of antibiotic prophylaxis in patients with transurethral resection of bladder tumours. Literature searches will be conducted in several electronic databases (from inception onwards), including MEDLINE (Ovid), EMBASE (Ovid), and the Cochrane Central Register of Controlled Trials (CENTRAL). Grey literature will be identified through searching conference abstracts. The primary outcome will be postoperative urinary tract infections. The secondary outcome will be asymptomatic bacteriuria. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using appropriate tools (e.g. Risk of Bias 2.0 tool and Newcastle-Ottawa Scale). If feasible, we will conduct random-effects meta-analysis of outcome data. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. study design, publication year, the setting of the study, and antibiotics regimen).We will also search, identify, and discuss potential risk factors for urinary tract infections following transurethral resection of bladder tumours. This may serve as basis for a scoping review.DiscussionIn times of rising antimicrobial resistance rates, sound evidence on the necessity of antibiotic prophylaxis is essential for implementation into guideline recommendations and for decision-making in clinical practice.Systematic review registrationPROSPERO, CRD42019131733

Highlights

The necessity of antibiotic prophylaxis for postoperative urinary tract infections (UTIs) after transurethral resection of bladder tumours is controversial
A lack of consensus was demonstrated in a recently published review that investigated the guidelines of the American Urological Association (AUA) and the Canadian (CAU), European (EAU), and Japanese (JAU) Associations of Urology [7]: The AUA considers Transurethral resection of bladder tumours (TURB) along with Transurethral resection of the prostate (TURP) and antibiotic prophylaxis (AP) should be applied to all patients, whereas the Canadian Association of Urology (CAU) groups TURB with cystoscopy and recommends AP only in high-risk patients
Interventions and comparators: We will include any scheme of AP vs. placebo and that report at least one pertinent outcome in patients undergoing TURB

Summary

Introduction

The necessity of antibiotic prophylaxis for postoperative urinary tract infections (UTIs) after transurethral resection of bladder tumours is controversial. This potentially leads to the overuse of antibiotic prophylaxis and rising antimicrobial resistance rates. According to the World Health Organization, transurethral resection of bladder tumours (TURB) is classified as a clean-contaminated wound procedure [3]. In clean-contaminated procedures, perioperative antibiotic prophylaxis (AP) is recommended to prevent postoperative urinary tract infections (UTIs) [4]. JAU guidelines recommend AP for TURB based on data for other transurethral procedures but state that low-risk cases without preoperative UTI can be considered to require no AP. A closer definition of these risk factors is missing in the EAU guidelines

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