• 1. 四川大學華西醫(yī)院泌尿科,成都,6100412. 四川大學華西臨床醫(yī)學院,臨床流行病學教研室;

目的 　探討術(shù)前為清潔尿準備行經(jīng)尿道前列腺切除術(shù)(transurethral resection of prostate,TURP)的患者,預防性應(yīng)用抗生素對術(shù)后菌尿的預防是否有效.
方法 　按Cochrane協(xié)作網(wǎng)工作手冊的要求,制定相應(yīng)的納入標準、排除標準及檢索策略,檢索美國醫(yī)學索引、荷蘭醫(yī)學文摘藥理學分冊、中國生物醫(yī)學文摘及Cochrane圖書館的隨機對照試驗文獻.對收集的文獻按循證醫(yī)學的原則和方法進行評價,資料按統(tǒng)一的表格進行提取,應(yīng)用RevMan軟件進行數(shù)據(jù)處理.
結(jié)果 　共檢索到相關(guān)文獻53篇,其中符合納入標準的有27篇、排除26篇.Meta-分析結(jié)果表明,對于術(shù)前為清潔尿的患者,預防性應(yīng)用抗生素能顯著降低TURP術(shù)后1周內(nèi)菌尿的發(fā)生率,RR合并=0.36,95%CI(0.28,0.46).
結(jié)論 　對于術(shù)前為清潔尿的患者,預防性應(yīng)用抗生素能減少TURP術(shù)后菌尿的發(fā)生率,但抗生素的最佳應(yīng)用方案及成本-效果分析尚需進一步研究.

引用本文： 吳建臣,魏強,楊宇如,劉關(guān)鍵,盧一平. 抗生素對經(jīng)尿道前列腺切除術(shù)后菌尿預防效果的系統(tǒng)評價. 中國循證醫(yī)學雜志, 2004, 04(2): 98-103. doi: 復制

1. ［1］Holtgrewe HL. Current trends in management of men with lower urinary tract symptoms and benign prostatic hyperplasia[J]. Urology, 1998; 51(Suppl 4A):1-7.
2. ［2］Mebust WK, Holtgrewe HL, Cockett AT, Peters PC.Transurethral prostatectomy: immediate and postoperative complications. Cooperative study of 13 participating institutions evaluating 3 885 patients[J]. J Urol., 2002; 167(1) :5-9.
3. ［3］Mulrow CD, Oxman AD. The Cochrane Collaboration handbook, Issue 1,2000,Oxford,Update Software.
4. ［4］Bannister G, Arkell DG and Menday AP. Prostatectomy and prophylaxis[J]. J Antimicrob Chemother, 1981; 7 (2): 209-210.
5. ［5］Botto H, Richard F, Mathieu F, Perreau AM, Camey M.Short-Vterm proohylaxis with cefotaxime in prostatic surgery[J]. J Antimicrob Chemother, 1984; 14 (Suppl B) :231-235.
6. ［6］Charton M, Dosne B, Escovar P, Kopf A, Brisset JM. Single Vdose preventive treatment of urinary tract infections after endoscopic resection of the prostate [J ]. Presse Med., 1984;13(9): 545-548.
7. ［7］Charton M, Vallancien G, Veillon B, Brisset JM. Antibiotic prophylaxis of urinary tract infection after transurethral resection of the prostate: A randomized study[J]. J Urol., 1987; 138(1) :87-89.
8. ［8］Conn IG, Moffat LE. Short-term cephradine prophylaxis in elective transurethral prostatectomy [ J ]. J Hosp Infect, 1988;11 (4): 373-375.
9. ［9］Desai KM, Abrams PH, White LO. A double Vblind comparative trial of short Vterm orally administered enoxacin in the prevention of urinary infection after elective transurethral prostatectomy: A clinical and pharmacokinetic study [J ]. J Urol., 1988; 139(6):1232V1234.
10. ［10］Fair WB. Perioperative use of carbenicillin in transurethral resection ofprostate[J]. J Urol., 1986;272 (Suppl 1) :15-18.
11. ［11］Ferrie BG, Scott R. Prophylactic Cefuroxime in transurethral resection[J]. Urol Res, 1984 ;12 (6): 279-281.
12. ［12］Finkelstein LH, Arsht DB, Manfrey SJ, Childs S. Ceftriaxone in the prevention of postoperative infection in patients undergoing transurethral resection of the prostate [ J ]. Am J Surg, 1984;19(4A): 19-21.
13. ［13］Gibbons RP, Stark RA, Correa RJJr, Cummings KB,Mason JT. The prophylactic use-or misuse-of antibiotics in transurethral prostatectomy[J]. J Urol., 1978 ;119(3): 381-383.
14. ［14］Gonzalez R, Wright R, Blackard CE. Prophylactic antibiotics in transurethral prostatectomy[J ]. J Urol., 1976; 116 (2) :203-205.
15. ［15］Hargreave TB, Botto H, Rikken GH, Hindmarsh JR,Mc Dermott TE, Mjolnerod OK,Petays P, Schalkhauser HK,Stellos A. European collaborative study of antibiotic prophylaxis for transurethral resection of the prostate[J ]. Eur Urol, 1993; 23(4): 437443.
16. ［16］Harvey MH, Leese T, Lloyd D, Osborn DE. Antibiotic prophylaxis and secondary haemorrhage following transurethral resection of the prostate: a prospective trial [J ]. Br J Urol.,1986; 58(4): 450-452.
17. ［17］Holl WH, Rous SN. Is antibiotic prophylaxis worthwhile in patients with transurethral resection of prostate[J] ? Urology,1982 ;19(1): 43-46.
18. ［18］Houle AM, Mokhless I, Sarto N, Elhilali MM. Perioperative antibiotic prophylaxis for transurethral resection of the prostate:is it justifiable[J] ? J Urol., 1989; 142(2 pt 1): 317-319.
19. ［19］Matthew AD, Gonzalez R, Jeffords D, Pinto MH. Prevention of bactefiuria after transurethral prostatectomy with nitrofurantoin macrocrystals[J ]. J Urol., 1978; 120 (4):442-443.
20. ［20］Morris MJ, Golovsky D, Guinness MD, Maher PO. The value of prophylactic antibiotics in tranurethral prostatic resection: a controlled trial, with observations on the origin of postoperative infection [J ]. Br J Urol., 1976; 48 (6):479V484.
21. ［21］Nielsen OS, Maigaard S, Frimodt-Moller N, Madsen PO.Prophylatic antibiotics in transurethral prostatectomy [ J ]. J Urol., 1981 ;126(1) :60-62.
22. ［22］Qvist N, Christiansen HM, Ehlers D. Prophylactic antibiotics in transurethral prostatectomy[J ]. Urol Res, 1984; 12 (6) :275-277.
23. ［23］Raz R, Almog D, Elhanan G, Shental J. The use of ceftriaxone in the prevention of urinary tract infection in patients undergoing transurethral resection of the prostate (TUR-P)[J]. Infection, 1994; 22(5): 347-349.
24. ［24］Rocca Rossetti S, Boccafoschi C, Pellegrini A, Campo B,Rigatti P, Bono A,Ventriglia L. Aztreonam Hmonotherapy as prophylaxis in transurethral resection of the prostate: a multicentre study [ J ]. Rev Infect Dis, 1991; 13 (Suppl 7):626-628.
25. ［25］Scholz M, Luftenegger W, Hanmuth H, Wolf D, Holtl W.Single-dose antibiotic prophylaxis in transurethral resection of the prostate: a prospective randomized trial[ J ]. Br J Urol.,1998; 81 (6): 827-329.
26. ［26］Slavis SA, Miller JB, Golji H, Dunshee CJ. Comparison of single-dose antibiotic prophylaxis in uncomplicated transurethral resection of the prostate [ J ]. J Urol., 1992; 147 (5): 1303-1306.
27. ［27］Stricker PD, Grant AB. Relative value of antibiotics and catheter care in the prevention of urinary tract infection after transurethral prostatic resection [J]. Br J Urol., 1988; 61(6): 494-497.
28. ［28］Taylor EW, Lindsay G. Antibiotic prophylaxis in transurethral resection of the prostate with reference to the influence of preoperative catheterization [J ]. J Hosp Infect. 1988; 12 (2):75-83.
29. ［29］Viitanen J, Talja M, Jussila E, Nurmi M, Permi J, Puolakka VM, Rintala E, Salmela H, Tiitinen J, Tuhkanen K.Randomized controlled study of chemoprophylaxis in transurethral prostatectomy[J]. J Urol., 1993; 1505 (Pt 2):1715-1717.
30. ［30］Weiss J, Wein A, Jacobs J, Hanno P. Use of nitrofurantoin macrocrystals after transurethral prostatectomy [ J ]. J Urol.,1983; 130(3) :479-480.
31. ［31］Robinson MR, Arudpragasam ST, Sahgal SM, Cross RJ,Akdas A, Fittal B, Sibbald R. Bacteremia resulting from prostatic surgery: The sourse of bacteria [ J ]. Br. J Urol.,1982; 54(5): 542-546.
32. ［32］Grabe M. Short antibiotic courses in transurethral prostatic resection. Scand J Urol. Nephrol, 1984 ;78 (1) :4.
33. ［33］Wear JB, Haley P. transurethral prostatectomy without antibiotics[J]. J Urol., 1973; 110(4): 436-440.
34. ［34］Robinson MR, Cross RJ, Shetty MB, Fittall B. Bacteraemia and bacteriogenic shock in district hospital urologocal practice[J]. Br J Urol., 1980; 52(1): 10-14.
35. ［35］Balbay MD, Ergen A, Sahin A, Lekili M, Ulucay S,Karaagaoglu E. Development of urethral stricture after transurethral prostatectomy: a retrospective study [ J ]. Int Urol. Nephol, 1992; 24(1): 49-53.
  1. 1. ［1］Holtgrewe HL. Current trends in management of men with lower urinary tract symptoms and benign prostatic hyperplasia[J]. Urology, 1998; 51(Suppl 4A):1-7.
  2. 2. ［2］Mebust WK, Holtgrewe HL, Cockett AT, Peters PC.Transurethral prostatectomy: immediate and postoperative complications. Cooperative study of 13 participating institutions evaluating 3 885 patients[J]. J Urol., 2002; 167(1) :5-9.
  3. 3. ［3］Mulrow CD, Oxman AD. The Cochrane Collaboration handbook, Issue 1,2000,Oxford,Update Software.
  4. 4. ［4］Bannister G, Arkell DG and Menday AP. Prostatectomy and prophylaxis[J]. J Antimicrob Chemother, 1981; 7 (2): 209-210.
  5. 5. ［5］Botto H, Richard F, Mathieu F, Perreau AM, Camey M.Short-Vterm proohylaxis with cefotaxime in prostatic surgery[J]. J Antimicrob Chemother, 1984; 14 (Suppl B) :231-235.
  6. 6. ［6］Charton M, Dosne B, Escovar P, Kopf A, Brisset JM. Single Vdose preventive treatment of urinary tract infections after endoscopic resection of the prostate [J ]. Presse Med., 1984;13(9): 545-548.
  7. 7. ［7］Charton M, Vallancien G, Veillon B, Brisset JM. Antibiotic prophylaxis of urinary tract infection after transurethral resection of the prostate: A randomized study[J]. J Urol., 1987; 138(1) :87-89.
  8. 8. ［8］Conn IG, Moffat LE. Short-term cephradine prophylaxis in elective transurethral prostatectomy [ J ]. J Hosp Infect, 1988;11 (4): 373-375.
  9. 9. ［9］Desai KM, Abrams PH, White LO. A double Vblind comparative trial of short Vterm orally administered enoxacin in the prevention of urinary infection after elective transurethral prostatectomy: A clinical and pharmacokinetic study [J ]. J Urol., 1988; 139(6):1232V1234.
  10. 10. ［10］Fair WB. Perioperative use of carbenicillin in transurethral resection ofprostate[J]. J Urol., 1986;272 (Suppl 1) :15-18.
  11. 11. ［11］Ferrie BG, Scott R. Prophylactic Cefuroxime in transurethral resection[J]. Urol Res, 1984 ;12 (6): 279-281.
  12. 12. ［12］Finkelstein LH, Arsht DB, Manfrey SJ, Childs S. Ceftriaxone in the prevention of postoperative infection in patients undergoing transurethral resection of the prostate [ J ]. Am J Surg, 1984;19(4A): 19-21.
  13. 13. ［13］Gibbons RP, Stark RA, Correa RJJr, Cummings KB,Mason JT. The prophylactic use-or misuse-of antibiotics in transurethral prostatectomy[J]. J Urol., 1978 ;119(3): 381-383.
  14. 14. ［14］Gonzalez R, Wright R, Blackard CE. Prophylactic antibiotics in transurethral prostatectomy[J ]. J Urol., 1976; 116 (2) :203-205.
  15. 15. ［15］Hargreave TB, Botto H, Rikken GH, Hindmarsh JR,Mc Dermott TE, Mjolnerod OK,Petays P, Schalkhauser HK,Stellos A. European collaborative study of antibiotic prophylaxis for transurethral resection of the prostate[J ]. Eur Urol, 1993; 23(4): 437443.
  16. 16. ［16］Harvey MH, Leese T, Lloyd D, Osborn DE. Antibiotic prophylaxis and secondary haemorrhage following transurethral resection of the prostate: a prospective trial [J ]. Br J Urol.,1986; 58(4): 450-452.
  17. 17. ［17］Holl WH, Rous SN. Is antibiotic prophylaxis worthwhile in patients with transurethral resection of prostate[J] ? Urology,1982 ;19(1): 43-46.
  18. 18. ［18］Houle AM, Mokhless I, Sarto N, Elhilali MM. Perioperative antibiotic prophylaxis for transurethral resection of the prostate:is it justifiable[J] ? J Urol., 1989; 142(2 pt 1): 317-319.
  19. 19. ［19］Matthew AD, Gonzalez R, Jeffords D, Pinto MH. Prevention of bactefiuria after transurethral prostatectomy with nitrofurantoin macrocrystals[J ]. J Urol., 1978; 120 (4):442-443.
  20. 20. ［20］Morris MJ, Golovsky D, Guinness MD, Maher PO. The value of prophylactic antibiotics in tranurethral prostatic resection: a controlled trial, with observations on the origin of postoperative infection [J ]. Br J Urol., 1976; 48 (6):479V484.
  21. 21. ［21］Nielsen OS, Maigaard S, Frimodt-Moller N, Madsen PO.Prophylatic antibiotics in transurethral prostatectomy [ J ]. J Urol., 1981 ;126(1) :60-62.
  22. 22. ［22］Qvist N, Christiansen HM, Ehlers D. Prophylactic antibiotics in transurethral prostatectomy[J ]. Urol Res, 1984; 12 (6) :275-277.
  23. 23. ［23］Raz R, Almog D, Elhanan G, Shental J. The use of ceftriaxone in the prevention of urinary tract infection in patients undergoing transurethral resection of the prostate (TUR-P)[J]. Infection, 1994; 22(5): 347-349.
  24. 24. ［24］Rocca Rossetti S, Boccafoschi C, Pellegrini A, Campo B,Rigatti P, Bono A,Ventriglia L. Aztreonam Hmonotherapy as prophylaxis in transurethral resection of the prostate: a multicentre study [ J ]. Rev Infect Dis, 1991; 13 (Suppl 7):626-628.
  25. 25. ［25］Scholz M, Luftenegger W, Hanmuth H, Wolf D, Holtl W.Single-dose antibiotic prophylaxis in transurethral resection of the prostate: a prospective randomized trial[ J ]. Br J Urol.,1998; 81 (6): 827-329.
  26. 26. ［26］Slavis SA, Miller JB, Golji H, Dunshee CJ. Comparison of single-dose antibiotic prophylaxis in uncomplicated transurethral resection of the prostate [ J ]. J Urol., 1992; 147 (5): 1303-1306.
  27. 27. ［27］Stricker PD, Grant AB. Relative value of antibiotics and catheter care in the prevention of urinary tract infection after transurethral prostatic resection [J]. Br J Urol., 1988; 61(6): 494-497.
  28. 28. ［28］Taylor EW, Lindsay G. Antibiotic prophylaxis in transurethral resection of the prostate with reference to the influence of preoperative catheterization [J ]. J Hosp Infect. 1988; 12 (2):75-83.
  29. 29. ［29］Viitanen J, Talja M, Jussila E, Nurmi M, Permi J, Puolakka VM, Rintala E, Salmela H, Tiitinen J, Tuhkanen K.Randomized controlled study of chemoprophylaxis in transurethral prostatectomy[J]. J Urol., 1993; 1505 (Pt 2):1715-1717.
  30. 30. ［30］Weiss J, Wein A, Jacobs J, Hanno P. Use of nitrofurantoin macrocrystals after transurethral prostatectomy [ J ]. J Urol.,1983; 130(3) :479-480.
  31. 31. ［31］Robinson MR, Arudpragasam ST, Sahgal SM, Cross RJ,Akdas A, Fittal B, Sibbald R. Bacteremia resulting from prostatic surgery: The sourse of bacteria [ J ]. Br. J Urol.,1982; 54(5): 542-546.
  32. 32. ［32］Grabe M. Short antibiotic courses in transurethral prostatic resection. Scand J Urol. Nephrol, 1984 ;78 (1) :4.
  33. 33. ［33］Wear JB, Haley P. transurethral prostatectomy without antibiotics[J]. J Urol., 1973; 110(4): 436-440.
  34. 34. ［34］Robinson MR, Cross RJ, Shetty MB, Fittall B. Bacteraemia and bacteriogenic shock in district hospital urologocal practice[J]. Br J Urol., 1980; 52(1): 10-14.
  35. 35. ［35］Balbay MD, Ergen A, Sahin A, Lekili M, Ulucay S,Karaagaoglu E. Development of urethral stricture after transurethral prostatectomy: a retrospective study [ J ]. Int Urol. Nephol, 1992; 24(1): 49-53.