Antibiotics prophylaxis at the time of catheter removal after radical prostatectomy: a systematic review of the literature and meta-analysis

Santos, Letícia Lourenço dos; Fraga, Isabela de Almeida; Almeida, Vitor Amaral de; Santos, Andressa Hellen Ribeiro; Almeida, Isabelle Matos; Nascimento, Tatiana Roberta; Porto, Breno Cordeiro; Passerotti, Carlo Camargo; Artifon, Everson Luiz de Almeida; Otoch, Jose Pinhata; Cruz, José Arnaldo Shiomi da

doi:10.1590/acb390424

Letícia Lourenço dos Santos

Substantive scientific and intellectual contributions to the study

Acquisition of data

Universidade Nove de Julho – São Paulo (SP) – Brazil.

http://orcid.org/0009-0006-4053-2425

Isabela de Almeida Fraga

Substantive scientific and intellectual contributions to the study

Acquisition of data

Universidade Nove de Julho – São Paulo (SP) – Brazil.

http://orcid.org/0009-0008-8304-3167

Vitor Amaral de Almeida

Analysis and interpretation of data

Technical procedures

Universidade Nove de Julho – São Paulo (SP) – Brazil.

http://orcid.org/0009-0003-3727-7820

Andressa Hellen Ribeiro Santos

Analysis and interpretation of data

Technical procedures

Manuscript writing

Universidade Nove de Julho – São Paulo (SP) – Brazil.

http://orcid.org/0009-0001-5853-4959

Isabelle Matos Almeida

Technical procedures

Statistics analysis

Universidade Nove de Julho – São Paulo (SP) – Brazil.

http://orcid.org/0009-0006-5838-7203

Tatiana Roberta Nascimento

Statistics analysis

Manuscript preparation

Universidade Nove de Julho – São Paulo (SP) – Brazil.

http://orcid.org/0009-0007-0819-9113

Breno Cordeiro Porto

Substantive scientific and intellectual contributions to the study

Acquisition of data

Analysis and interpretation of data

Technical procedures

Statistics analysis

Manuscript preparation

Manuscript writing

Universidade de São Paulo – School of Medicine – Surgical Technique and Experimental Surgery – São Paulo (SP) – Brazil.

http://orcid.org/0000-0002-4004-4089

Carlo Camargo Passerotti

Analysis and interpretation of data

Universidade de São Paulo – School of Medicine – Surgical Technique and Experimental Surgery – São Paulo (SP) – Brazil.

Hospital Alemão Oswaldo Cruz – Specialized Center for Urology – São Paulo (SP) – Brazil.

http://orcid.org/0000-0003-3023-6797

Everson Luiz de Almeida Artifon

Critical revision

Universidade de São Paulo – School of Medicine – Surgical Technique and Experimental Surgery – São Paulo (SP) – Brazil.

http://orcid.org/0000-0003-1900-8777

Jose Pinhata Otoch

Critical revision

Universidade de São Paulo – School of Medicine – Surgical Technique and Experimental Surgery – São Paulo (SP) – Brazil.

http://orcid.org/0000-0002-8293-1508

José Arnaldo Shiomi da Cruz ^**Corresponding author: arnaldoshiomi@yahoo.com.br

Statistics analysis

Manuscript preparation

Critical revision

Universidade Nove de Julho – São Paulo (SP) – Brazil.

Universidade de São Paulo – School of Medicine – Surgical Technique and Experimental Surgery – São Paulo (SP) – Brazil.

Hospital Alemão Oswaldo Cruz – Specialized Center for Urology – São Paulo (SP) – Brazil.

http://orcid.org/0000-0003-4203-3196

*Corresponding author: arnaldoshiomi@yahoo.com.br

Section editor: Cristina Camargo https://orcid.org/0000-0002-3134-0003

Conflict of interest

Nothing to declare.

About the authors

Santos LL, Fraga IA, Almeida VA, Santos AHR, Almeida IM, Nascimento TR and Porto BC are medicine students.

Passerotti CC, Artifon ELA, Otoch JP and Cruz JAS are MDs, PhDs.

Study	Type of study	Patients enrolled (N), antibiotic/control	Mean age (years), antibiotic/control	Mean BMI (Kg/m²2 Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents. 2004;23(Suppl.1):S17–23. https://doi.org/10.1016/j.ijantimicag.2003.09.005 https://doi.org/10.1016/j.ijantimicag.20... ), antibiotic/control	Mean PSA (ng/dL), antibiotic/control	UTI (N), antibiotic/control	Positive urine culture (N), antibiotic/control	Antibiotic used and dose	Catheter duration (days), antibiotic/control	Postoperative complications (Clavien-Dindo), antibiotic/control	UTI definition
Fang et al.⁸8 Fang Y-Q Li T-C, Si T-J, Pang J, Gao X. Antibiotic prophylaxis at time of catheter removal following laparoscopic radical prostatectomy: a prospective randomized study. Acta Medica Mediterranea. 2014;30:161–5.	Randomized prospective trial	80/80	65^* * median ± NS/66^* * median ± NS	NS/NS	1.64^* * median ± NS/1.76^* * median ± NS	3/2	7/9	Oral ciprofloxacin, 500 mg, once daily, for seven days	8^* * median ± 3.5/9^* * median ± 2.7	3 patients grade I (3.75%), 2 grade III (2.5%)/3 patients grade I (3.8%), 2 grade III (1.3%)	Fever associated with urinary symptoms
Berrondo et al.⁹9 Berrondo C, Feng C, Kukreja JB, Messing EM, Joseph JV. Antibiotic prophylaxis at the time of catheter removal after radical prostatectomy: A prospective randomized clinical trial. Urol Oncol. 2019;37(3):181.e7-181.e14. https://doi.org/10.1016/j.urolonc.2018.10.029 https://doi.org/10.1016/j.urolonc.2018.1...	Randomized prospective trial	83/84	62.49 ± 6.86/62.98 ± 6.82	28.95 ± 5.06/29.41 ± 5.30	11.03 ± 23.31/7.77 ± 5.36	3/5	26/56	Oral ciprofloxacin, 500 mg, twice daily, for one day	9.82 ± 1.77/10.08 ± 1.81	8 patients grade I (9.6%)/12 patients grade I (14.3%)	Positive urine culture with at least one organism exceeding 100,000 CFU/mL, coupled with the presence of at least one symptom or sign compatible with UTI
Pinochet et al.¹⁰10 Pinochet R, Nogueira L, Cronin AM, Katz D, Rabbani F, Guillonneau B, Touijer K. Role of short-term antibiotic therapy at the moment of catheter removal after laparoscopic radical prostatectomy. Urol Int. 2010;85(4):415–20. https://doi.org/10.1159/000321094 https://doi.org/10.1159/000321094...	Non-randomized retrospective trial	261/452	60^* * median ± NS/60^* * median ± NS	28^* * median ± NS/27^* * median ± NS	NS/NS	8/33	NS/NS	Oral ciprofloxacin, 500 mg, twice daily, for three days	11 ± NS/7 ± NS	52 patients grade I (20%), 16 grade II (6%), 32 grade III (12%), 1 grade V (0.4%)/91 patients grade I (20%), 34 grade II (8%), 61 grade III (13%)	Patients with lower urinary tract symptoms suggestive of UTI (e.g., burning sensation, increased frequency, and urgency)

Study or Subgroup	Antibiotic		Control			Odds Ratio	Odds Ratio
Study or Subgroup	Events	Total	Events	Total	Weight	M-H, Random,95% CI	M-H, Random,95% CI
Berrondo	26	83	56	84	56.0%	0.23 [0.12, 0.44]
Fang, 2014	7	80	9	80	44.0%	0.76 [0.27, 2.14]
Total (95% CI)		163		164	100.0%	0.39 [0.12, 1.24]
Total events	33		65
Heterogeneity: Tau²2 Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents. 2004;23(Suppl.1):S17–23. https://doi.org/10.1016/j.ijantimicag.2003.09.005 https://doi.org/10.1016/j.ijantimicag.20... = 0.52; Chi²2 Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents. 2004;23(Suppl.1):S17–23. https://doi.org/10.1016/j.ijantimicag.2003.09.005 https://doi.org/10.1016/j.ijantimicag.20... = 3.67, df = 1 (P = 0.06); I²2 Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents. 2004;23(Suppl.1):S17–23. https://doi.org/10.1016/j.ijantimicag.2003.09.005 https://doi.org/10.1016/j.ijantimicag.20... = 73%
Test for overall effect Z = 1.60 (P = 0.11)

Study or Subgroup	Antibiotic		Control			Odds Ratio	Odds Ratio
Study or Subgroup	Events	Total	Events	Total	Weight	M-H, Random,95% CI	M-H, Random,95% CI
Berrondo, 2019	3	83	5	84	19.6%	0.59 [0.14, 2.56]
Fang, 2014	3	80	2	80	12.7%	1.52 [0.25, 9.35]
Pinochet, 2010	8	261	33	452	67.7%	0.40 [0.18, 0.88]
Total (95% CI)		424		616	100.0%	0.51 [0.27, 0.98]
Total events	33		65
Heterogeneity: Tau²2 Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents. 2004;23(Suppl.1):S17–23. https://doi.org/10.1016/j.ijantimicag.2003.09.005 https://doi.org/10.1016/j.ijantimicag.20... = 0.00; Chi²2 Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents. 2004;23(Suppl.1):S17–23. https://doi.org/10.1016/j.ijantimicag.2003.09.005 https://doi.org/10.1016/j.ijantimicag.20... = 1.78, df = 2 (P = 0.41); I²2 Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents. 2004;23(Suppl.1):S17–23. https://doi.org/10.1016/j.ijantimicag.2003.09.005 https://doi.org/10.1016/j.ijantimicag.20... = 0%
Test for overall effect: Z = 2.02 (P = 0.04)

[1] *Corresponding author: arnaldoshiomi@yahoo.com.br

Brasil

Brasil

Antibiotics prophylaxis at the time of catheter removal after radical prostatectomy: a systematic review of the literature and meta-analysis

ABSTRACT

Purpose:

Methods:

Results:

Conclusions: