Antibiotic Prophylaxis in Men Undergoing Transurethral Resection of Prostate: A Systematic Review and Network Meta-Analysis
Abstract
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…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 6,939 participants or records.
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