ABSTRACT
Aims: Despite guidelines and recommendations, a pragmatic approach, i.e., that treatment will improve patient-centered outcomes when performed by typical clinicians in typical patients, is necessary to evaluate the effectiveness of antibiotic prophylaxis in urological surgery. Study Design: Prospective, randomized, double-blinded, pragmatic trial. Place and Duration: The study was performed in a tertiary hospital at Federal University of Uberlandia, Brazil, from January 2012 to December 2013. Methods: One hundred and thirty patients were randomly assigned to receive a single dose of 2 g intravenous (IV) ceftriaxone (66 subjects) or 2 g IV cefazolin (64 subjects) thirty minutes before transurethral resection of the prostate (TURP). We evaluated their physical status, preoperative urinary catheter use, urological risk factors, prostate size, and the duration of surgery. Results: Ceftriaxone showed a non-significant trend towards superiority to cefazolin (OR = 0.567, 95% CI [0.234-1.414], p = 0.228) for the prevention of infections among TURP patients. Conclusion: No significant difference in the effectiveness of a single dose of ceftriaxone compared with cefazolin for the prevention of postoperative infections was found in patients undergoing TURP following the early postoperative removal of an indwelling catheter. Due to the pragmatic assumptions of this trial, this result might not represent a negative finding; instead, it may indicate the importance of risk factors influencing the patients’ susceptibility to infection.