Efficacy of fosfomycin in the prevention of postoperative infection following transurethral resection of bladder tumor during periods of limited cefazolin, cefotiam, and cefmetazole supply. Issue 4 (April 2021)

• Record Type: Journal Article
• Authors: Etani, Toshiki; Asaoka, Minami; Kondo, Shuhei; Wachino, Chiharu; Hori, Kaoru; Shimizu, Nobuhiko; Noda, Yusuke; Nagai, Takashi; Nozaki, Satoshi; Iida, Keitaro; Naiki, Taku; Ando, Ryosuke; Kawai, Noriyasu; Yanagita, Takeshi; Nakamura, Atsushi; Yasui, Takahiro
• Is Part Of: Journal of infection and chemotherapy. Volume 27:Issue 4(2021)
• Page Start: 625
• Page End: 631
• Publication Date: 2021-04
• Subjects: Cefazolin -- Cefotiam -- Fosfomycin -- Prophylactic antibiotic -- Transurethral resection of the bladder tumor; Chemotherapy -- Periodicals; Infection -- Periodicals; Communicable diseases -- Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1016/j.jiac.2020.11.025
• Languages: English
• ISSNs: 1341-321X

Abstract

Abstract: Introduction: In March 2019, cefazolin availability was limited owing to the contamination of the drug substance. In addition, there was a difficulty in supplying drugs alternative to cefazolin, such as cefotiam and cefmetazole. In our Department of Nephro-urology, we used fosfomycin-based drugs to substitute cefazolin as perioperative preventive antibacterial drugs. In this study, we aimed to evaluate the usage status of perioperative prophylactic antibacterial drugs before and after the period of limited cefazolin supply and to investigate the efficacy and safety of fosfomycin sodium in preventing infections following transurethral resection of bladder tumor. Methods: We enrolled 346 patients who underwent transurethral resection of bladder tumor in our department from April 2018 to August 2020. The patients received the following perioperative antibacterial agents: cefotiam (n = 146), fosfomycin (n = 166), and other antibacterial agents (n = 34). There was no significant difference in the median age or surgery time. Results: The median length of hospital stay was 6, 5, and 5 days in the cefotiam, fosfomycin, and other antibacterial groups, respectively, with significant difference. The median maximum postoperative temperature was 37.1 °C in all groups, with no significant difference. There were no differences in C-reactive protein, aspartate aminotransferase, and alanine aminotransferase levels determined by postoperative blood tests; preoperative and postoperative urinary white blood cell counts; preoperative urine bacterial counts; and surgery-related infection requiring additional antibiotic treatments among the groups. Conclusions: The use of fosfomycin-based agents helped overcome the limited supply of cefazolin without worsening clinical outcomes.