Use of antimicrobials for patients undergoing prostatectomy.

Our suggestions for the use of antimicrobials in patients undergoing prostatectomy are summarized in Table 2. The use of antimicrobial prophylaxis perioperatively for patients without bacteriuria remains controversial. Some authors recommend and others do not recommend antimicrobial prophylaxis. We do not recommend perioperative prophylaxis for low-risk patients without previous urinary tract infections or an indwelling urethral catheter. We do recommend that patients with risk factors that increase the rate or consequence of urinary tract infection, those with previous urinary tract infections, or those with indwelling urethral catheters, even though the urine shows no growth, receive perioperative antimicrobial prophylaxis. Antimicrobial therapy is mandatory for patients with preoperative bacteriuria. The drug must be selected according to the susceptibility of the pathogen, and the duration of treatment must be guided by the severity of the infection. At the time of catheter removal, antimicrobial prophylaxis is probably beneficial, and antimicrobial therapy is essential if bacteriuria is present prior to catheter removal. All patients must have cultures after catheter removal and antimicrobial therapy if a urinary tract infection is identified.