Objectives: The purpose of this study was to analyze the risk factors of postoperative infection following transurethral resection of the prostate (TURP). Methods: 857 consecutive patients scheduled for TURP were included in a French multicenter prospective study (12 surgical centers). For each patient, data were collected and analyzed as risk factors of postoperative infection. Statistical analysis used the χ2 test or Student’s test for univariate analysis, then stepwise logistic regression for multivariate analysis. Results: The incidence of post-TURP infection was 21.6%: urinary tract infection (19.3%) and bacteremia and/or septic shock (2.3%). Multivariate analysis documented three independent risk factors of postoperative infection: preoperative bacteriuria (p < 0.003), duration of surgical procedure >70 min (p < 0.01) and the surgical center (p < 0.00001). Conclusion: The duration of the surgical procedure is an important postoperative risk factor of infection and there is a major difference between centers in terms of postoperative risk of infection. Further studies are needed to explain this last phenomenon.

Keywords:
Prospective studies, Risk factors, Prostatectomy, Postoperative complications, Urinary tract infection, Bacteremia
1.
Carson CC: Complications of minimally invasive treatment modalities for benign prostatic hyperplasia; in Carson CC (ed): Topics in Clinical Urology. Complications of Interventional Techniques. New York, Igaku-Shoin, 1996, pp 1–14.
2.
Mebust WK: Transurethral surgery; in Walsh PC, Retik AB, Stamey TA, Vaughan ED (ed): Campbell’s Urology, ed 6. Philadelphia, Saunders, 1992, pp 2900–2922.
3.
Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, Barnejee SN, Edwards JR, Tolson JS, Henderson TS: Surgical wound infection rates by wound class, operative procedure and patient risk-index. Am J Med 1991;91:152S–157S.
4.
Altemeier WA, Burke JF, Pruitt B Jr, Sandosky WR: Definition and classifications of surgical infection; in Manual on Control of Infection in Surgical Patients. Philadelphia, Lippincott, 1984, pp 29–30.
5.
Keats AS: The ASA classification of physical status. A recapitulation. Anesthesiology 1978;49:233–236.
6.
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG: CDC definitions of nosocomial surgical site infections, 1992: A modification of CDC definitions of surgical wound infection. Infect Control Hosp Epidemiol 1992;13:606–608.
7.
Bone RC, Fischer CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA: A controlled clinical trial of high dose methyl-prednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 1987;317:353–358.
8.
Platt R, Polk BF, Murdock B, Rosner B: Risk factors for nosocomial urinary tract infection. Am J Epidemiol 1986;124:977–985.
9.
Ohkawa M, Shimanura M, Tokunaga S, Nakashima T, Orito M: Bacteremia resulting from prostatic surgery in patients with or without preoperative bacteremia under perioperative antibiotic use. Chemotherapy 1993;39:140–146.
10.
Robinson MR, Arudpragasam ST, Sahgal SM, Cross RJ, Akdas A, Fittal B, Sibbald R: Bacteremia resulting from prostatic surgery: The source of bacteria. Br J Urol 1982;54:542–546.
11.
Evans JP, Smart DG, Bagshaw PF: Bacterial content of enucleated prostate glands. Urology 1981;4:328–331.
12.
Shiina H, Himeno T, Ishibe T: Organisms in the prostate and antibiotics in the treatment of postoperative infections. Urol Int 1992;48:187–190.
13.
Krogh J, Jensen JS, Iversen HG, Andersen JT: Age as a prognostic variable in patients undergoing transurethral prostatectomy. Scand J Urol Nephrol 1993;27:225–229.
14.
Hargreave TB, Botto H, Rikken GH, Hindmarsh JR, Mac Dermott TE, Mjolnerod OK, Petays P, Schalkhäuser K, Stellos A: European collaborative study of antibiotic prophylaxis for transurethral resection of the prostate. Eur Urol 1993;23:437–439.
15.
Ibrahim AI, Bilal NE, Shetty SD, Patil KP, Gommaa H: The source of organisms in the post-prostatectomy bacteriuria of patients with preoperative sterile urine. Br J Urol 1993;72:770–774.
16.
Brendler CB: Perioperative care; in Walsh PC, Retik AB, Stamey TA, Vaughan ED (ed): Campbell’s Urology, ed 6. Philadelphia, Saunders, 1992, pp 2315–2358.
17.
Martin C: Antimicrobial prophylaxis in surgery: General concepts and clinical guidelines. The French study group on antimicrobial prophylaxis in surgery, the French Society of Anesthesia and Intensive Care. Infect Control Hosp Epidemiol 1994;15:463–471.
18.
Hull R, Raskob G, Pineo G, Rosenbloom D, Evans W, Mallory T, Anquist K, Smith F, Hughes G, Green G: A comparison of subcutaneous low molecular weight heparin with warfarin sodium for prophylaxis against deep vein thrombosis after hip or knee implantation. N Engl J Med 1993;329:1370–1375.
19.
Haley RW, Culver DH, White JW: The efficacy of infection surveillance and control programs in preventing nosocomial infection in US hospitals. Am J Epidemiol 1985;121:182–205.
1998
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