Antimicrobial Prophylaxis in Urology and Transplantation

Abstract

The main source of infection in urological practice is from the presence of an indwelling catheter. The risk of catheteracquired infection is determined by the duration of catheterization, the adequacy of free drainage, and the efficiency of the closed drainage system. Many catheter-acquired infections are due to multiresistant strains of Escherichia coli, Klebsiella sp.,Pseudomonas aeruginosa, Proteus sp., and Providentia sp. Antibiotic prophylaxis has no place in the prevention of catheter-acquired infections, and prophylaxis should be achieved by scrupulous aseptic technique and reducing the duration of drainage. The problems of catheters in the paraplegic are discussed. Septicemia and endotoxemia are the most feared complications of cystoscopy and retropubic prostatectomy if the urinary tract is infected and of transrectal biopsy of the prostate. For this reason, antibiotic cover is generally advised for these procedures. Sepsis is still a major cause of death in patients who have received a renal transplant. These infections are not only bacterial, but viral, protozoal, and fungal. The severity and frequency of these infections have been reduced by less aggressive immunosuppression. There is probably a place for perioperative antibiotic cover, but long-term antibiotics should be avoided.