What is the recommended treatment for a urinary tract infection (UTI) following a transurethral resection of the prostate (TURP)?

Treatment of UTI Following TURP

For UTI following transurethral resection of the prostate (TURP), fluoroquinolones such as levofloxacin are the recommended first-line treatment due to their excellent urinary tract penetration and broad spectrum coverage of common uropathogens.

Diagnostic Approach

• Confirm UTI diagnosis through:
  • Urinalysis showing pyuria (>10 WBC/mm³)
  • Urine culture with >10⁴ CFU/mL in midstream specimens or >10² CFU/mL in catheter specimens 1
  • Assessment of symptoms (dysuria, frequency, urgency, suprapubic pain, fever)

Treatment Algorithm

First-Line Treatment

• Levofloxacin 250-500mg once daily for 7-10 days 2, 3
  • Achieves high concentrations in urinary tract tissues after a 250mg oral dose
  • Effective against most common uropathogens (98-99% susceptibility)
  • Provides excellent coverage for both gram-negative and gram-positive bacteria

Alternative Treatment

• Trimethoprim-sulfamethoxazole (TMP-SMX) 4
  • Dosage: 160/800mg (double strength) twice daily for 7-10 days
  • Consider when fluoroquinolones are contraindicated or local resistance patterns warrant

For Severe Infections

• Hospitalization with initial intravenous antimicrobial therapy 5
• Switch to oral therapy once clinically improved
• Total treatment duration of 14 days

Special Considerations

Risk Factors for Complicated UTI Post-TURP

• Preoperative bacteriuria
• Prolonged catheterization
• Advanced age
• Diabetes mellitus
• Immunosuppression
• Incomplete bladder emptying/high post-void residual

Important Clinical Pitfalls

1. Do not treat asymptomatic bacteriuria unless preparing for another urological procedure 6

   • The IDSA guidelines specifically recommend against treating asymptomatic bacteriuria in most cases

2. Distinguish between true UTI and asymptomatic bacteriuria

   • True UTI requires both bacteriuria and symptoms
   • Asymptomatic bacteriuria is common after TURP but does not require treatment

3. Consider antibiotic resistance patterns

   • Local resistance to aminopenicillins and TMP-SMX has been increasing
   • Fluoroquinolones generally maintain better susceptibility profiles 3

4. Recurrent or persistent UTI in men with BPH may indicate:

   • Incomplete resection requiring further surgical intervention
   • Urinary retention
   • Presence of urinary stones or other anatomical abnormalities 5

Prevention of Future UTIs

• For patients with recurrent UTIs following TURP:
  • Consider imaging of the upper urinary tract to identify underlying abnormalities 5
  • Evaluate for residual prostatic tissue or incomplete bladder emptying
  • Consider intravesical therapy with BCG for patients with bladder cancer who underwent TURBT 6

By following this treatment approach, most UTIs following TURP can be effectively managed while minimizing complications and preventing recurrence.