Antibiotic Prophylaxis in Men Undergoing Transurethral Resection of Prostate: A Systematic Review and Network Meta-Analysis.

OBJECTIVES

To analyze the effects of antibiotic prophylaxis (ATBp) prior to transurethral resection of the prostate (TURP) and rank the antibiotic classes.

METHODS

We searched PubMed, Web of Science, Embase, CENTRAL, and clinical trials registries for randomized controlled trials (RCTs) from their inceptions through October 2024. We included all RCTs that compared ATBp to placebo or no agent (Plac/No agt) and to each other. Risk ratios (RR), mean differences (MD) and 95% confidence intervals (CI) were estimated by a frequentist network meta-analysis. Treatments were ranked by the surface under the cumulative ranking (SUCRA).

RESULTS

We included 45 RCTs (n = 6939), in which ATBp reduced the risk of early (RR: 0.32, CI: 0.28-0.36), and late bacteriuria (RR: 0.50, CI: 0.41-0.62), septicemia/bacteremia (RR: 0.37, CI: 0.26-0.54), fever (RR: 0.60, CI: 0.52-0.70), and length of stay (MD: -0.67, CI: -1.07-[-0.27]) compared to Plac/No agt. Death (RR: 0.62, CI: 0.22-1.76) and adverse effects (RR: 1.33, CI: 0.72-2.46) were nonsignificant. Treatments with the best ranking were: 1st generation cephalosporin plus nitrofuran (early bacteriuria, SUCRA = 0.86), 2nd generation cephalosporin (late bacteriuria, SUCRA = 0.91), lincosamide plus aminoglycoside (septicemia/bacteremia, SUCRA = 0.85), phosphonic (fever, SUCRA = 1.00), lincosamide plus aminoglycoside (length of stay, SUCRA = 1.00), penicillin (death, SUCRA = 0.75), and Plac/No agt (adverse effects, SUCRA = 0.68).

CONCLUSIONS

ATBp was superior to Plac/No agt in most endpoints and should be done routinely before TURP with varying effects according to antibiotic classes, which should be considered before adequate prophylaxis.