What are the risks of postoperative infection after prostatectomy (prostate surgery)?

From the Guidelines

Infections after prostate surgery are a serious complication that requires prompt medical attention, and the most recent evidence suggests that antibiotic prophylaxis should be used judiciously, with the American Urological Association (AUA) recommending specific regimens, but recent studies indicating that these regimens may not always be effective in preventing postoperative infections 1. Infections after prostate surgery can manifest in various ways, including fever, increased pain, redness or warmth around the incision site, foul-smelling or cloudy urine, increased urinary frequency or urgency, and chills or general malaise.

• Common signs of post-prostate surgery infection include:
  • Fever above 101°F
  • Increased pain
  • Redness or warmth around the incision site
  • Foul-smelling or cloudy urine
  • Increased urinary frequency or urgency
  • Chills or general malaise Treatment typically involves antibiotics, with fluoroquinolones (such as ciprofloxacin 500mg twice daily for 7-14 days) or trimethoprim-sulfamethoxazole (160/800mg twice daily for 7-14 days) commonly prescribed for urinary tract infections 1.
• For more severe infections, hospitalization may be necessary for intravenous antibiotics like ceftriaxone or gentamicin. To prevent infections, it is essential to:
• Take all prescribed antibiotics as directed
• Maintain good hygiene, especially around the catheter if present
• Drink plenty of fluids to flush bacteria from the urinary tract
• Attend all follow-up appointments Infections occur because surgery creates temporary vulnerabilities in the urinary tract and surrounding tissues, allowing bacteria to enter and multiply, with risk factors including diabetes, advanced age, prolonged catheterization, and compromised immune function 1. The most recent and highest quality study suggests that the use of antibiotic prophylaxis in patients undergoing primary penile implantation may actually be associated with a higher risk of postoperative infection, highlighting the need for careful consideration of the risks and benefits of antibiotic prophylaxis in this population 1.

From the Research

Infection after Prostate Surgery

• Infection is a potential complication after prostate surgery, including transrectal ultrasound-guided prostate biopsy (TRUS Bx) 2, 3, 4, 5, 6.
• The use of antibiotic prophylaxis can reduce the risk of infection after prostate biopsy 2, 3, 4, 5, 6.
• Different antibiotic regimens have been studied, including ciprofloxacin plus metronidazole 2, 3, ciprofloxacin plus amikacin 4, and levofloxacin alone or in combination with amikacin 6.
• The addition of amikacin to ciprofloxacin or levofloxacin has been shown to reduce the incidence of infectious complications in some studies 2, 4, but not in others 6.
• A systematic review and meta-analysis found that antibiotic prophylaxis reduced infectious complications compared to no prophylaxis, and that a long-term prophylaxis (1 to 7 days) was superior to a short-term prophylaxis (single shot to 3 days) with fluoroquinolone 5.
• The certainty of evidence for antibiotic prophylaxis in prostate biopsy is generally rated as low or very low due to the heterogeneity of the studies and the variability in the outcomes measured 5.

Risk Factors for Infection

• The risk of infection after prostate biopsy is increased in patients with certain underlying medical conditions, such as diabetes or immunosuppression 5.
• The use of fluoroquinolone-resistant bacteria is also a risk factor for infection after prostate biopsy 4, 6.
• The route and timing of antibiotic prophylaxis do not appear to affect the incidence of infectious complications 5.

Prevention and Treatment

• The use of antibiotic prophylaxis is recommended to prevent infectious complications after prostate biopsy 2, 3, 4, 5, 6.
• The choice of antibiotic regimen should be based on the patient's individual risk factors and the local prevalence of antibiotic-resistant bacteria 5.
• In cases where infection does occur, treatment with antibiotics effective against the causative organism is necessary 4, 6.