TY - JOUR
T1 - A multi-center prospective study for antibiotic prophylaxis to prevent perioperative infections in urologic surgery
AU - Yamamoto, Shingo
AU - Kunishima, Yasuharu
AU - Kanamaru, Sojun
AU - Ito, Noriyuki
AU - Kinoshita, Hidefumi
AU - Kamoto, Toshiyuki
AU - Ogawa, Osamu
AU - Arai, Yoichi
AU - Terachi, Toshiro
AU - Okumura, Kazuhiro
AU - Moroi, Seiji
AU - Okada, Yusaku
AU - Kanamaru, Hirofumi
AU - Asazuma, Akira
AU - Sasaki, Miharu
AU - Hida, Shuichi
AU - Terai, Akito
AU - Nishimura, Kazuo
AU - Horii, Yasuki
AU - Nishio, Yasunori
AU - Inui, Masashi
AU - Kanatani, Isao
AU - Nishikawa, Nobuyuki
AU - Nonomura, Mitsuo
AU - Ogura, Keiji
AU - Mitsumori, Kenji
AU - Onishi, Hiroyuki
AU - Yamasaki, Toshinari
PY - 2004/10
Y1 - 2004/10
N2 - In order to assess the ability of our protocol for antibiotic prophylaxis to prevent perioperative infections in urologic surgery, 1,353 operations of open and laparoscopic urologic surgery conducted in 21 hospitals between September 2002 and August 2003 were subjected to analyses. We classified surgical procedures into four categories by invasiveness and contamination levels : Category A ; clean less invasive surgery, Category B ; clean invasive or clean-contaminated surgery, Category C ; surgery with urinary tract diversion using the intestine. Prophylactic antibiotics were administrated intravenously according to our protocol, such as Category A ; first or second generation cephems or penicillins on the operative day only, Category B ; first and second generation cephems or penicillins for 3 days, and Category C ; first, second or third generation cephems or penicillins for 4 days. The wound conditions and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 30. The SSI rate highest (23.3%) for surgery with intestinal urinary diversion, followed by 10.0% for surgery for lower urinary tract, 8.9% for nephroureterctomy, and 6.0% for radical prostatectomy. The SSI rates in clean surgery including open and laparoscopic nephrectomy/adrenalectomy were 0.7 and 1.4%, respectively. In SSIs, gram-positive cocci such as methicillin-resistant staphylococcus aureus (58.8%) or Enterobacter faecalis (26.5%) were the most common pathogen. Similarly, the RI rate was the highest (35.2%) for surgery using intestinal urinary diversion, followed by 16.7% for surgery for lower urinary tract, 11.4% for nephroureterctomy, and 7.6% for radical prostatectomy, while RI rates for clean surgery were less than 5%. RIs most frequently reported were urinary tract infections (2.6%) where Pseudomonas aeruginosa (20.3%) and Enterobacter faecalis (15.3%) were the major causative microorganisms. Parameters such as age, obesity, nutritional status (low proteinemia), diabetes mellitus, lung disease, duration of operation, and blood loss volume were recognized as risk factors for SSI or RI in several operative procedures. Postoperative body temperatures, peripheral white blood counts, C reactive protein (CRP) levels in POD 3 were much higher than those in POD 2 in cases suffering from perioperative infections, especially suggesting that CRP could be a predictable marker for perioperative infections.
AB - In order to assess the ability of our protocol for antibiotic prophylaxis to prevent perioperative infections in urologic surgery, 1,353 operations of open and laparoscopic urologic surgery conducted in 21 hospitals between September 2002 and August 2003 were subjected to analyses. We classified surgical procedures into four categories by invasiveness and contamination levels : Category A ; clean less invasive surgery, Category B ; clean invasive or clean-contaminated surgery, Category C ; surgery with urinary tract diversion using the intestine. Prophylactic antibiotics were administrated intravenously according to our protocol, such as Category A ; first or second generation cephems or penicillins on the operative day only, Category B ; first and second generation cephems or penicillins for 3 days, and Category C ; first, second or third generation cephems or penicillins for 4 days. The wound conditions and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 30. The SSI rate highest (23.3%) for surgery with intestinal urinary diversion, followed by 10.0% for surgery for lower urinary tract, 8.9% for nephroureterctomy, and 6.0% for radical prostatectomy. The SSI rates in clean surgery including open and laparoscopic nephrectomy/adrenalectomy were 0.7 and 1.4%, respectively. In SSIs, gram-positive cocci such as methicillin-resistant staphylococcus aureus (58.8%) or Enterobacter faecalis (26.5%) were the most common pathogen. Similarly, the RI rate was the highest (35.2%) for surgery using intestinal urinary diversion, followed by 16.7% for surgery for lower urinary tract, 11.4% for nephroureterctomy, and 7.6% for radical prostatectomy, while RI rates for clean surgery were less than 5%. RIs most frequently reported were urinary tract infections (2.6%) where Pseudomonas aeruginosa (20.3%) and Enterobacter faecalis (15.3%) were the major causative microorganisms. Parameters such as age, obesity, nutritional status (low proteinemia), diabetes mellitus, lung disease, duration of operation, and blood loss volume were recognized as risk factors for SSI or RI in several operative procedures. Postoperative body temperatures, peripheral white blood counts, C reactive protein (CRP) levels in POD 3 were much higher than those in POD 2 in cases suffering from perioperative infections, especially suggesting that CRP could be a predictable marker for perioperative infections.
KW - Remote infection
KW - Surgical site infection
KW - Urologic surgery
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M3 - Article
C2 - 15575217
AN - SCOPUS:9144245597
VL - 50
SP - 673
EP - 683
JO - Acta Urologica Japonica
JF - Acta Urologica Japonica
SN - 0018-1994
IS - 10
ER -