nach oben

Erschienen in:

01.02.2012 | Topic Paper

Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures

verfasst von: Magnus Grabe, Henry Botto, Mete Cek, Peter Tenke, Florian M. E. Wagenlehner, Kurt G. Naber, Truls E. Bjerklund Johansen

Erschienen in: World Journal of Urology | Ausgabe 1/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To assess the patient and identify the risk factors for infectious complications in conjunction with urological procedures and suggest a model for classification of the procedures.

Method

Review of literature, critical analysis of data and tentative model for reducing infectious complications.

Results

Risk factors are bound to the patient and to the procedure itself and are associated with the environment where the healthcare is provided. Assuming a clean environment and sterile operation field, a five-level assessment ladder related to the patient and type of surgery is useful, considering: (1) the ASA score, (2) the general risk factors, (3) the individual endogenous and exogenous risk factors, (4) the class of surgery and the potential bacterial contamination burden and (5) the level of severity and difficulty of the surgical intervention. A cumulative approach will identify the level of risk for each patient and define preventive measures, such as the type of antibiotic prophylaxis or therapeutic measures before surgery. There are data suggesting that the higher the ASA score, the higher is the risk of infectious complication. Age, dysfunction of the immune system, hypo-albuminaemia/malnutrition and overweight, uncontrolled blood glucose level and smoking are independent general risk factors, whilst bacteriuria, indwelling catheter treatment, urinary tract stone disease, urinary tract obstruction and a history of urogenital infection are specific urological risk factors. There is inconclusive evidence for most other reported risk factors. The level of contamination of the surgical field is of utmost importance as are the procedure-related factors, and the sum of these have to be reflected on for the subsequent perioperative management of the patient.

Conclusions

It is essential to identify and control risk factors to minimize infectious complications in conjunction with urological procedures. Our knowledge is limited and clinical research and quality registries analysing risk factors must be undertaken. We propose a working basis for assessment of patients’ risk factors and classification of urological procedures.

Grabe M, Shortliffe L, Arakawa S, Kitamura T et al (2001) Risk factors, in Nosocomial and Health Care Associated infections in urology. 1st International Consultations on Nosocomial and Health Care Associated infections in urology 2000, Paris. Naber K, Pechère JC, Kumazawa J, Khoury S, et al (eds) Plymbridge Distributors Ltd

Department of Health and Human Services, Public Health Service (1992), Agency for health care policy and research, pp 115–127

Abrams P, Khoury S, Grant A (2007) Evidence–based medicine overview of the main steps for developing and grading guideline recommendations. Prog Urol 17(3):681–684PubMedCrossRef

Mangram AJ, Horan TC, Pearson ML, Silver LC, and Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20(4): 250–78; quiz 279-80

Pagano M, Gauvreau K (2000) Principles of biostatistics, 2nd ed. Australia; Pacific Grove, CA: Duxbury. 1 v. (various pagings)

American Society of Anesthesiologists. ASA physical Status Classification System. Available from: http://asahq.org/clinical/physicalstatus.htm

Woodfield JC, Beshay NM, Pettigrew RA, Plank LD, van Rij AM (2007) American society of anesthesiologists classification of physical status as a predictor of wound infection. ANZ J Surg 77(9):738–741PubMedCrossRef

Haridas M, Malangoni MA (2008) Predictive factors for surgical site infection in general surgery. Surgery 144(4):496–501 (discussion 501-3)PubMedCrossRef

Ambiru S, Kato A, Kimura F, Shimizu H, Yoshidome H, Otsuka M, Miyazaki M (2008) Poor postoperative blood glucose control increases surgical site infections after surgery for hepato-biliary-pancreatic cancer: a prospective study in a high-volume institute in Japan. J Hosp Infect 68(3):230–233PubMedCrossRef

10.

Dronge AS, Perkal MF, Kancir S, Concato J, Aslan M, Rosenthal RA (2006) Long-term glycemic control and postoperative infectious complications. Arch Surg 141(4):375–380 (discussion 380)PubMedCrossRef

11.

Shilling AM, Raphael J (2008) Diabetes, hyperglycemia, and infections. Best Pract Res Clin Anaesthesiol 22(3):519–535PubMedCrossRef

12.

Geerlings SE (2008) Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. Int J Antimicrob Agents 31(Suppl 1):S54–S57PubMedCrossRef

13.

Stapleton A (2002) Urinary tract infections in patients with diabetes. Am J Med 113(Suppl 1A):80S–84SPubMedCrossRef

14.

Cheadle WG (2006) Risk factors for surgical site infection. Surg Infect (Larchmt) 7(Suppl 1):S7–S11CrossRef

15.

Schneider SM, Veyres P, Pivot X, Soummer AM, Jambou P, Filippi J, van Obberghen E, Hebuterne X (2004) Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr 92(1):105–111PubMedCrossRef

16.

Bjerklund Johansen TE, Cek M, Naber K, Stratchounski L, Svendsen MV, Tenke P (2007) Prevalence of hospital-acquired urinary tract infections in urology departments. Eur Urol 51(4):1100–1112 discussion 1112PubMedCrossRef

17.

Helmholz HF Sr (1950) Determination of the bacterial content of the urethra: a new method, with results of a study of 82 men. J Urol 64(1):158–166PubMed

18.

Foxman B (2002) Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 113(Suppl 1A):5S–13SPubMedCrossRef

19.

Grabe M (1987) Antimicrobial agents in transurethral prostatic resection. J Urol 138(2):245–252PubMed

20.

Grabe M, Hellsten S (1986) Bacteriuria a risk factor in men with bladder outlet obstruction. In: Kass EH, Svanborg Eden C (eds) Host Parasite interactions in urinary tract infection. University of Chicago Press, Chicago, pp 303–306

21.

Evans JP, Smart JG, Bagshaw PF (1981) Bacterial content of enucleated prostate glands. Urology 17(4):328–331PubMedCrossRef

22.

Soto SM, Smithson A, Martinez JA, Horcajada JP, Mensa J, Vila J (2007) Biofilm formation in uropathogenic Escherichia coli strains: relationship with prostatitis, urovirulence factors and antimicrobial resistance. J Urol 177(1):365–368PubMedCrossRef

23.

Hugosson J, Grenabo L, Hedelin H, Pettersson S, Seeberg S (1990) Bacteriology of upper urinary tract stones. J Urol 143(5):965–968PubMed

24.

Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 173(5):1610–1614PubMedCrossRef

25.

Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J (1991) Prediction of septicemia following endourological manipulation for stones in the upper urinary tract. J Urol 146(4):955–960PubMed

26.

Lindstedt S, Lindstrom U, Ljunggren E, Wullt B, Grabe M (2006) Single-dose antibiotic prophylaxis in core prostate biopsy: Impact of timing and identification of risk factors. Eur Urol 50(4):832–837PubMedCrossRef

27.

Robinson MR, Arudpragasam ST, Sahgal SM, Cross RJ, Akdas A, Fittal B, Sibbald R (1982) Bacteraemia resulting from prostatic surgery: the source of bacteria. Br J Urol 54(5):542–546PubMedCrossRef

28.

Tenke P, Kovacs B, Bjerklund Johansen TE, Matsumoto T, Tambyah PA, Naber KG (2008) European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents 31(Suppl 1):S68–S78PubMedCrossRef

29.

Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, Banerjee SN, Edwards JR, Tolson JS, Henderson TS et al (1991) Surgical wound infection rates by wound class, operative procedure, and patient risk index national nosocomial infections surveillance system. Am J Med 91(3B):152S–157SPubMedCrossRef

30.

Grabe M (2004) Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents 23(Suppl 1):S17–S23PubMedCrossRef

31.

Montgomery JS, Johnston WK 3rd, Wolf JS Jr (2005) Wound complications after hand assisted laparoscopic surgery. J Urol 174(6):2226–2230PubMedCrossRef

32.

Lunevicius R, Morkevicius M (2005) Systematic review comparing laparoscopic and open repair for perforated peptic ulcer. Br J Surg 92(10):1195–1207PubMedCrossRef

33.

de Oliveira AC, Ciosak SI, Ferraz EM, Grinbaum RS (2006) Surgical site infection in patients submitted to digestive surgery: risk prediction and the NNIS risk index. Am J Infect Control 34(4):201–207PubMedCrossRef

34.

National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32(8): 470-85

35.

Greif R, Akca O, Horn EP, Kurz A, Sessler DI (2000) Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. Outcomes Research Group. N Engl J Med 342(3):161–167PubMedCrossRef

36.

Millborn D, Cengiz Y, Israelsson LA (2009) Effects of stitch length on wound complications after closure of midline incisions: a randomised controlled trial. Arch of Surg 144(11):1056–1059CrossRef

37.

Aus G, Ahlgren G, Bergdahl S, Hugosson J (1996) Infection after transrectal core biopsies of the prostate–risk factors and antibiotic prophylaxis. Br J Urol 77(6):851–855PubMedCrossRef

38.

Almallah YZ, Rennie CD, Stone J, Lancashire MJ (2000) Urinary tract infection and patient satisfaction after flexible cystoscopy and urodynamic evaluation. Urology 56(1):37–39PubMedCrossRef

39.

Burke DM, Shackley DC, O’Reilly PH (2002) The community-based morbidity of flexible cystoscopy. BJU Int 89(4):347–349PubMedCrossRef

40.

Johnson MI, Merrilees D, Robson WA, Lennon T, Masters J, Orr KE, Matthews JN, Neal DE (2007) Oral ciprofloxacin or trimethoprim reduces bacteriuria after flexible cystoscopy. BJU Int 100(4):826–829PubMedCrossRef

41.

Wilson L, Ryan J, Thelning C, Masters J, Tuckey J (2005) Is antibiotic prophylaxis required for flexible cystoscopy? A truncated randomized double-blind controlled trial. J Endourol 19(8):1006–1008PubMedCrossRef

42.

Latthe PM, Foon R, Toozs-Hobson P (2008) Prophylactic antibiotics in urodynamics: a systematic review of effectiveness and safety. Neurourol Urodyn 27(3):167–173PubMedCrossRef

43.

Larsson P, Norming U, Tornblom M, Gustafsson O (1999) Antibiotic prophylaxis for prostate biopsy: benefits and costs. Prostate Cancer Prostatic Dis 2(2):88–90PubMedCrossRef

44.

Puig J, Darnell A, Bermudez P, Malet A, Serrate G, Bare M, Prats J (2006) Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary? Eur Radiol 16(4):939–943PubMedCrossRef

45.

Aron M, Rajeev TP, Gupta NP (2000) Antibiotic prophylaxis for transrectal needle biopsy of the prostate: a randomized controlled study. BJU Int 85(6):682–685PubMedCrossRef

46.

Berry A, Barratt A (2002) Prophylactic antibiotic use in transurethral prostatic resection: a meta-analysis. J Urol 167(2 Pt 1):571–577PubMed

47.

Qiang W, Jianchen W, MacDonald R, Monga M, Wilt TJ (2005) Antibiotic prophylaxis for transurethral prostatic resection in men with preoperative urine containing less than 100, 000 bacteria per ml: a systematic review. J Urol 173(4):1175–1181PubMedCrossRef

48.

Charton M, Vallancien G, Veillon B, Prapotnich D, Mombet A, Brisset JM (1990) Use of antibiotics in the conjunction with extracorporeal lithotripsy. Eur Urol 17(2):134–138PubMed

49.

Bierkens AF, Hendrikx AJ, Ezz el Din KE, de la Rosette JJ, Horrevorts A, Doesburg W, Debruyne FM (1997) The value of antibiotic prophylaxis during extracorporeal shock wave lithotripsy in the prevention of urinary tract infections in patients with urine proven sterile prior to treatment. Eur Urol 31(1):30–35PubMed

50.

Pearle MS, Roehrborn CG (1997) Antimicrobial prophylaxis prior to shock wave lithotripsy in patients with sterile urine before treatment: a meta-analysis and cost-effectiveness analysis. Urology 49(5):679–686PubMedCrossRef

51.

Knopf HJ, Graff HJ, Schulze H (2003) Perioperative antibiotic prophylaxis in ureteroscopic stone removal. Eur Urol 44(1):115–118PubMedCrossRef

52.

Hendrikx AJ, Strijbos WE, de Knijff DW, Kums JJ, Doesburg WH, Lemmens WA (1999) Treatment for extended-mid and distal ureteral stones: SWL or ureteroscopy? Results of a multicenter study. J Endourol 13(10):727–733PubMedCrossRef

53.

Charton M, Vallancien G, Veillon B, Brisset JM (1986) Urinary tract infection in percutaneous surgery for renal calculi. J Urol 135(1):15–17PubMed

54.

Osman M, Wendt-Nordahl G, Heger K, Michel MS, Alken P, Knoll T (2005) Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int 96(6):875–878PubMedCrossRef

55.

Stranne J, Aus G, Hansson C, Lodding P, Pileblad E, Hugosson J (2004) Single-dose orally administered quinolone appears to be sufficient antibiotic prophylaxis for radical retropubic prostatectomy. Scand J Urol Nephrol 38(2):143–147PubMedCrossRef

56.

Sakura M, Kawakami S, Yoshida S, Masuda H, Kobayashi T, Kihara K (2008) Prospective comparative study of single dose versus 3-day administration of antimicrobial prophylaxis in minimum incision endoscopic radical prostatectomy. Int J Urol 15(4):328–331PubMedCrossRef

57.

Hara N, Kitamura Y, Saito T, Komatsubara S, Nishiyama T, Takahashi K (2008) Perioperative antibiotics in radical cystectomy with ileal conduit urinary diversion: efficacy and risk of antimicrobial prophylaxis on the operation day alone. Int J Urol 15(6):511–515PubMedCrossRef

58.

Kiddoo DA, Wollin TA, Mador DR (2004) A population based assessment of complications following outpatient hydrocelectomy and spermatocelectomy. J Urol 171(2 Pt 1):746–748PubMedCrossRef

59.

Swartz MA, Morgan TM, Krieger JN (2007) Complications of scrotal surgery for benign conditions. Urology 69(4):616–619PubMedCrossRef

60.

Carson CC (2003) Diagnosis, treatment and prevention of penile prosthesis infection. Int J Impot Res 15(Suppl 5):S139–S146PubMedCrossRef

Titel: Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures
verfasst von: Magnus Grabe
Henry Botto
Mete Cek
Peter Tenke
Florian M. E. Wagenlehner
Kurt G. Naber
Truls E. Bjerklund Johansen
Publikationsdatum: 01.02.2012
Verlag: Springer-Verlag
Erschienen in: World Journal of Urology / Ausgabe 1/2012
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-011-0722-z

Neu im Fachgebiet Urologie

10.04.2024 | PSA-Screening | Nachrichten

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures

Abstract

Purpose

Method

Results

Conclusions

Neu im Fachgebiet Urologie

Einladung zum PSA-Screening senkt die Krebssterblichkeit

Wie toxische Männlichkeit der Gesundheit von Männern schadet

TURP hat Vorteile im Vergleich mit der Embolisation

Langes Sitzen in der Freizeit korreliert mit erektiler Dysfunktion

Update Urologie

Springer Medizin

Abstract

Purpose

Method

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2012

Editorial

Urologic complications of genitourinary schistosomiasis

Male genital tuberculosis: epidemiology and diagnostic

Four-year functional results of the suburethral sling procedure for stress urinary incontinence: a French prospective randomized multicentre study comparing the retropubic and transobturator routes

Prognostic relevance of number and bilaterality of positive surgical margins after radical prostatectomy

Update on biofilm infections in the urinary tract

Neu im Fachgebiet Urologie

Einladung zum PSA-Screening senkt die Krebssterblichkeit

Wie toxische Männlichkeit der Gesundheit von Männern schadet

TURP hat Vorteile im Vergleich mit der Embolisation

Langes Sitzen in der Freizeit korreliert mit erektiler Dysfunktion

Update Urologie