Association between the levels of postoperative pyuria and urinary tract infection in patients undergoing Transurethral Anatomical Enucleation of Prostate (TUAEP) in Rajavithi Hospital

Abstract

Objective: Pyuria is a common condition that can occur after TUAEP. One possible cause is postoperative inflammation. To limit this many physicians prescribe antibiotic prophylaxis to prevent postoperative urinary tract infections, however this can lead to the overuse of antibiotics and increase the growing problem of antibiotic resistance. Therefore the object of this study is to evaluate the association between the level of postoperative pyuria and urinary tract infections in patients undergoing TUAEP and to identify other risk factors associated with postoperative urinary tract infection facilitating appropriate antibiotic management. Materials and Methods: Data from 94 patients who underwent TUAEP in Rajavithi Hospital from 1st December 2016 to 31st March 2021 were retrospectively analyzed. The data collected from medical records included demographic data, details from operative record sheets and laboratory results. Results: A significant association was found between a level of postoperative pyuria >100 WBCs/HPF and postoperative bacteriuria (46.15% vs 19.35%, p = 0.024). Diabetes mellitus and preoperative bacteriuria were also significant risk factors for postoperative bacteriuria. The bacterium which was the most frequently cultured from samples taken both preoperatively and postoperatively was Escherichia coli. Conclusion: The risk factors for postoperative bacteriuria in patients undergoing TUAEP are a level of postoperative pyuria > 100/HPF, diabetes mellitus and preoperative bacteriuria. It may be concluded from the results that the most frequent cause of postoperative pyuria was more likely to be due to a tissue reaction after surgery than from a urinary tract infection. Selective antibiotic treatment in patients who have these risk factors can reduce problems of antibiotic overuse and anti- biotic resistance.