Infections in urological practice: bacteraemia and infective endocarditis

Introduction. It is known that infections may occur after urological instrumentation, as some patients develop infective symptoms. The purpose of this study was to investigate bacteraemia in patients undergoing transurethral
resection of the prostate (TURP) and catheter manipulation, using contemporary culture methods. Another aim was to explore the potential for molecular methods to detect, identify and quantify bacteraemia. We aim to evaluate the association between urological instrumentation and the
development of infective endocarditis (IE).
Methods. Microbiological molecular methods to identify and quantify bacteria in blood were developed. Blood samples were collected at different time points during the procedure from patients undergoing TURP and catheter manipulation to evaluate the presence of bacteria using both the culture and molecular methods. The association between risk factors (patient and procedural) and
bacteraemia was analysed statistically. A case-control model was used to assess the association between the development of IE and a number of risk factors, including urological instrumentation.
Results. Bacteraemia occurred in both sets of patients though most patients were asymptomatic. In the TURP group, bacteraemia occurred within the first twenty minutes of the procedure in spite of antibiotics prophylaxis. In the
catheter manipulation group, bacteraemia was present even prior to any urological manipulation. The case-control model demonstrated an association between urological instrumentation and the development of IE.
Conclusion. This study has shown that bacteraemia during urological instrumentation is more prevalent than previously thought but is largely asymptomatic. Moreover, antibiotic prophylaxis in TURP patients fails to stop a
significant proportion of intra-procedure bacteraemias. Asymptomatic bacteraemia may explain the statistical association between urological instrumentation and IE has been demonstrated.