Taiwanese Recommendations for Antimicrobial Prophylaxis in Urological Surgery

Abstract

Objective: Surgical site infections and postoperative urinary tract infections are common causes of patient morbidity in urological surgery. Although the effectiveness of perisurgical antimicrobial prophylaxis (AMP) in reducing surgical site infections and postoperative urinary tract infections is well established, there is a wide variation in the use of AMP. Materials and Methods: Three panels of experts of the Taiwan Urological Association were invited to review the literature and the clinical path of each hospital, and to suggest recommendations for AMP in open and laparoscopic surgeries, office procedures, and endoscopic surgery in the urological field. Results: First-generation cephalosporins, usually not recommended in American and European guidelines, were recommended as first-line prophylactic antibiotics in Taiwan. The duration of AMP for each urological procedure was recommended and was usually limited to the period of a high risk of bacterial invasion. In patients with high-risk factors that increase the susceptibility to infection, a more-advanced agent with a longer duration is recommended. We do not discuss this agent in this article, but that does not preclude its appropriate use, depending on specific situations, including medical intolerance, agent compatibility, a history of previous infection, and community resistance patterns. Conclusions: Controlled trials employing well-designed protocols may clarify the efficacy and safety concerning the choice of AMP for urological procedures. Practical guidelines based on clinical studies can then hopefully be updated.