Postoperative Antibiotic Duration Affects Infectious Rates in High-Risk Patients Undergoing HoLEP

Background: Patients undergoing holmium laser enucleation of the prostate (HoLEP) are increasingly elderly, comorbid, and likely to present with asymptomatic bacteriuria. Postoperative infections are common in this growing subset, and optimal perioperative prophylactic antibiotic duration is understudied. Therefore, we aim to analyze the association between the postoperative antibiotics duration and the postoperative infection rates in patients undergoing HoLEP at increased risk for infection. Methods: This retrospective single-center cohort study was performed with patients undergoing HoLEP between 2018 and 2023. We included patients with risk factors for infection, including positive preoperative urine culture, catheter dependency, immunosuppression, history of urosepsis, history of pyelonephritis, or history of recurrent urinary tract infections (UTIs). Patients were categorized according to antibiotic duration in the postoperative setting as either short-term (≤3 days) or long-term (>3 days) groups. The primary outcome was the 30-day infection rate, defined as treatment provided for a clinically diagnosed UTI. Propensity score was applied for adjusted analysis. Results: We identified 204 high-risk patients, of which 76 were in the long-term group. The short-term group had an infection rate of 18.8% ( N = 24), while the long-term group had a rate of 6.6% ( N = 5) ( p = 0.016). The positive urine culture rate was 11.7% ( N = 15) in the short-term group and 3.9% ( N = 3) in the long-term group ( p = 0.074). After adjusting for factors associated with postoperative infection, the long-term group had a 12.1% lower chance of infectious complication than the short-term group (95% confidence interval [CI]: 3.4–20.9, p = 0.006). The long-term group had a 7.8% lower chance of positive urine culture than the short-term group (95% CI: 0.7–14.9, p = 0.032). Conclusion: This study demonstrated that postoperative antibiotic duration affects infectious complications rates in patients undergoing HoLEP with a higher risk of infection. When prescribing antibiotic prophylaxis, longer durations of postoperative antibiotics should be considered.