Editorial Comment on Antibiotic Prophylaxis in Men Undergoing Transurethral Resection of Prostate: A Systematic Review and Network Meta‐Analysis
Abstract
Transurethral resection of the prostate remains a cornerstone surgical therapy for benign prostatic hyperplasia; however, post-operative urinary tract infection (UTI) and urosepsis continue to pose challenges. The systematic review and network meta-analysis by Oliveira et al. address the important clinical issue of determining optimal antimicrobial prophylaxis regimens to reduce postoperative infectious complications in this population [1]. By synthesizing randomized trials and indirect comparisons among multiple antimicrobial classes, their analysis demonstrates that prophylaxis markedly lowers postoperative bacteriuria, septicemia/bacteremia, fever, and length of stay compared with no antimicrobial use, with varying protective effects across antimicrobial classes depending on the outcome measured. Importantly, extending prophylaxis (> 72 h) did not provide consistent additional benefit and was associated with a nonsignificant trend toward higher septicemia/bacteremia risk, highlighting the importance of avoiding unnecessary antimicrobial exposure. This comprehensive work advances previous pairwise meta-analyses by ranking regimens through network methodology and clarifying that short perioperative regimens targeting common uropathogens achieve the best balance be-tween efficacy and safety. Beyond reinforcing the value of prophylaxis, this study highlights several stewardship-relevant insights. More intensive or prolonged regimens did
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