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Review
. 2023 Dec 16;12(12):1744.
doi: 10.3390/antibiotics12121744.

Antimicrobial Prophylaxis in Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review

Eva Falkensammer  1   2 , Ece Erenler  3 , Truls E Bjerklund Johansen  4   5 , Lazaros Tzelves  6 , Laila Schneidewind  7 , Yuhong Yuan  8   9 , Tommaso Cai  10   11 , Bela Koves  12 , Zafer Tandogdu  13
Affiliations
Review

Antimicrobial Prophylaxis in Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review

Eva Falkensammer et al. Antibiotics (Basel). .

Abstract

It remains unclear whether antibiotic prophylaxis (AP) should be recommended or discouraged in robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer (PCa). The development of microbial resistance and side effects are risks of antibiotic use. This systematic review (SR) investigates the evidence base for AP in RALP. A systematic literature search was conducted until 12 January 2023, using Embase, MEDLINE, Cochrane CENTRAL, Cochrane CDSR (via Ovid) and CINAHL for studies reporting the effect of AP on postoperative infectious complications in RALP. Of 436 screened publications, 8 studies comprising 6378 RALP procedures met the inclusion criteria. There was no evidence of a difference in the rate and severity of infective complications within 30 days after RALP surgery between different AP protocols. No studies omitted AP. For patients who received AP, the overall occurrence of postoperative infectious complications varied between 0.6% and 6.6%. The reported urinary tract infection (UTI) rates varied from 0.16% (4/2500) to 8.9% (15/169). Wound infections were reported in 0.46% (4/865) to 1.12% (1/89). Sepsis/bacteraemia and hyperpyrexia were registered in 0.1% (1/1084) and 1.6% (5/317), respectively. Infected lymphoceles (iLC) rates were 0.9% (3 of 317) in a RALP cohort that included 88.6% pelvic lymph node dissections (PLND), and 3% (26 of 865) in a RALP cohort where all patients underwent PLND. Our findings underscore that AP is being administered in RALP procedures without scientifically proven evidence. Prospective studies that apply consistent and uniform criteria for measuring infectious complications and antibiotic-related side effects are needed to ensure the comparability of results and guidance on AP in RALP.

Keywords: antimicrobial prophylaxis/antibiotic prophylaxis (AP); postoperative infection; prostate cancer (PCa); robot-assisted laparoscopic radical prostatectomy (RALP); sepsis; surgical site infection (SSI); urinary tract infection (UTI).

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Conflict of interest statement

All authors declare that they have no conflict of interest regarding this manuscript.

Figures

Figure 1
Figure 1
Prisma flow diagram: Screening process of the literature [8].
Figure 2
Figure 2
Risk of bias assessment for the four included non-randomized studies of interventions utilizing the ROBINS-I tool [10,12,13,14,15].
See this image and copyright information in PMC

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