Antibacterial prophylaxis with fosfomycin at the time of the urethral catheter removal after radical prostatectomy (prospective randomized trial)
- Authors: Veliev E.I.1,2, Sokolov E.A.1,2, Metelev A.Y.2, Aliev E.N.2, Polyakova A.S.1, Ivkin E.V.2
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Affiliations:
- Russian Medical Academy of Continuous Professional Education (RMACPE), Department of Urology and Surgical Andrology
- S.P. Botkin’s State Clinical Hospital
- Issue: No 1 (2024)
- Pages: 35-40
- Section: Original Articles
- URL: https://journals.eco-vector.com/1728-2985/article/view/630532
- DOI: https://doi.org/10.18565/urology.2024.1.35-40
- ID: 630532
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Abstract
Aim. To evaluate the effect of antibacterial prophylaxis using oral fosfomycin during the removal of a urethral catheter after radical prostatectomy on the development of urinary tract infection, severity of leukocyturia and bacteriuria, as well as the severity of lower urinary tract symptoms.
Materials and methods. A single-center, non-blind, prospective, randomized controlled trial was carried out. The main group included 40 patients, and the control group included 37 patients. In the group 1, patients received two doses of oral fosfomycin, 3 g, namely in the evening on the day of catheter removal (the first dose) and 48 hours after catheter removal (the second dose). In the group 2, patients did not receive any antibacterial prophylaxis after urethral catheter removal. The endpoints of the study were confirmed episodes of urinary tract infection within 1 month after removal of the urethral catheter, leukocyturia and bacteriuria in urinalysis/urine culture) and severity of the lower urinary tract symptoms assessed by IPSS questionnaire.
Results. In the group 2, urinary tract infection was noted in 17.1%, while in the group 2 only in 2.6% of patients (p=0.032). Leukocyturia and bacteriuria were significantly less common in the group receiving antibacterial prophylaxis with fosfomycin (18.4% vs. 48.6%, respectively; p=0.006). Positive urine culture was observed in 7.9% vs. 25.7%, respectively (p=0.035). Four weeks after removal of the urethral catheter, the average IPSS score was significantly higher in the group 2 (13.2 vs. 9.5 points; p=0.002). There were no cases of allergic reaction and pseudomembranous colitis associated with C. difficile in both groups. Diarrhea cured with sorbents was noted in 2 patients (5.2%) in fosfomycin group.
Conclusion. Antibacterial prophylaxis using two oral doses of fosfomycin 3 g on the day of urethral catheter removal and 48 hours after catheter removal after radical prostatectomy appears to be an effective scheme that reduces the incidence of urinary tract infection and the severity of lower urinary tract symptoms, and is characterized by a minimal risk of adverse events. It is necessary to carried out further research and develop clear recommendations for antibacterial prevention in urological interventions requiring prolonged urethral catheterization.
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About the authors
E. I. Veliev
Russian Medical Academy of Continuous Professional Education (RMACPE), Department of Urology and Surgical Andrology; S.P. Botkin’s State Clinical Hospital
Email: veliev64@gmail.com
Ph.D., MD, professor, professor at the Department of Urology and Surgical Andrology of Russian Medical Academy of Continuous Professional Education (RMACPE), Head of the Department of Urology of S.P. Botkin’s State Clinical Hospital
Russian Federation, Moscow; MoscowE. A. Sokolov
Russian Medical Academy of Continuous Professional Education (RMACPE), Department of Urology and Surgical Andrology; S.P. Botkin’s State Clinical Hospital
Author for correspondence.
Email: info@drsokolov.ru
Ph.D., MD, associate professor of the Department of Urology and Surgical Andrology of Russian Medical Academy of Continuous Professional Education (RMACPE), urologist at the S.P. Botkin’s State Clinical Hospital
Russian Federation, Moscow; MoscowA. Yu. Metelev
S.P. Botkin’s State Clinical Hospital
Email: urometelev@mail.ru
Ph.D., oncologist, urologist at the S.P. Botkin’s State Clinical Hospital
Russian Federation, MoscowE. N. Aliev
S.P. Botkin’s State Clinical Hospital
Email: esedulaaliev@mail.ru
resident at the S.P. Botkin’s State Clinical Hospital
Russian Federation, MoscowA. S. Polyakova
Russian Medical Academy of Continuous Professional Education (RMACPE), Department of Urology and Surgical Andrology
Email: plkvs46@mail.ru
Ph.D. student at the Department of Urology and Surgical Andrology of Russian Medical Academy of Continuous Professional Education (RMACPE)
Russian Federation, MoscowE. V. Ivkin
S.P. Botkin’s State Clinical Hospital
Email: e.ivkin@hotmail.com
Ph.D., oncologist, urologist at the S.P. Botkin’s State Clinical Hospital
Russian Federation, MoscowReferences
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