The use of
antibiotic prophylaxis to prevent
urinary tract infection and
bacteremia (
sepsis) following endoscopic urologic procedures is a controversial topic. Evidence in the literature revealed that urological instrumentation is associated with increased incidence of
urinary tract infection and
bacteremia. The aim of this review is to evaluate the effectiveness of
antibiotic prophylaxis in reducing the risk of
urinary tract infection in patients who had transurethral urological surgeries. We have selected all RCTs of adult population who underwent all different types of transurethral urological surgery, including cystoscopy,
transurethral resection of prostate and
transurethral resection of bladder tumor, and received prophylactic
antibiotics or placebo/no treatment. At first, more than 3000 references were identified and reviewed; of which 42 studies with a total of 7496 patients were included in the final analysis. All those trials were analyzing
antibiotic prophylaxis versus placebo/no treatment, and they were significantly favoring
antibiotic use in reducing all outcomes, including
bacteriuria (RR 0.36, 95% CI 0.29 to 0.46, P < 0.0001) with moderate heterogeneity detected (I(2) 48%), symptomatic UTI (RR 0.38, 95% CI 0.28 to 0.51, P < 0.0001) with no significant heterogeneity was detected (I(2)= 17%),
bacteremia (RR 0.43, 95% CI 0.23 to 0.82, P < 0.0001) with no noted heterogeneity (I(2) = 0%), and
fever ≥38.5 Celsius (RR 0.41, 95% CI 0.23 to 0.73, P = 0.003); also, there was no noted heterogeneity (I(2) = 0%). However, using
antibiotic prophylaxis did not reduce the incidence of low grade temperature (RR 0.82, 95% CI 0.61 to 1.11, P = 0.20) or in moderate grade temperature (RR 1.03, 95% CI 0.71 to 1.48, P = 0.89).
Antibiotic prophylaxis appears to be an effective intervention in preventing
urinary tract infections and its sequels following transurethral urological surgeries in patients with preoperative sterile urine.