An economic analysis of antimicrobial prophylaxis against urinary tract infection in patients undergoing transurethral resection of the prostate

Despite the high level of safety and low incidence of mortality associated with transurethral resection of the prostate (TURP), urinary tract infectio ns (UTIs)-the most common complication associated with this procedure-conti nue to be an important source of postoperative morbidity and costs. However , there is controversy about whether antimicrobial agents should be used as UTI prophylaxis in patients undergoing TURF and, if so, which agents shoul d be used and for what duration. This retrospective study used multivariate regression analysis to evaluate the different types and durations of antib iotic prophylaxis in 222 patients who underwent TURF at a Veterans Affairs hospital between January 1, 1995, and March 30, 1998. The primary outcome m easures were total medical costs tie, medication use, clinic office visits, and hospital care in the 4 weeks after the procedure), length of hospital stay (total days in hospital due to the procedure), and probability of UTI (incidence of infection in the 4 weeks after the procedure). Results showed that there was no difference in the length of hospital stay regardless of the regimen or duration of pre-TURF antibiotic therapy. Patients who receiv ed pre-TURF ampicillin plus ceftizoxime incurred moderately higher total me dical costs than did patients who received the least costly drug, cefazolin (P = 0.10). Similarly, patients who received post-TURF quinolones incurred a significantly higher total medical cost than did patients who received c o-trimoxazole (P = 0.06). We found no evidence of a relationship between us e of specific parenteral or oral antibiotic prophylaxis for UTI in patients undergoing TURF and the rate of UTI in such patients. Thus there is no jus tification for the use of more expensive antibiotic regimens. At our instit ution, the preferred pre-TURF prophylactic regimen would be cefazolin, wher eas co-trimoxazole would be the most cost-effective post-TURF prophylactic regimen. Because duration of post-TURF prophylaxis does not appear to influ ence the rate of UTI, 24 hours would seem adequate.