Ciprofloxacin versus gentamicin in prophylaxis against bacteremia in transrectal prostate needle biopsy

Roach, Martha; George, William J.; Figueroa, T. Ernesto; Neal, Durwood E.; McBride, Dan

doi:10.1016/0090-4295(91)80024-2

Cited by 53 publications

(27 citation statements)

References 10 publications

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“…[5][6][7] With good tissue penetration and randomized trials supporting its benefit, ciprofloxacin is our choice of prophylactic agent for TRUS-guided prostate biopsy. 8,9 No difference between a prophylactic single dose administration and a 3-day course has been noted, but these studies are likely underpowered. [7][8][9][10] A longer course is probably warranted in men with risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 No difference between a prophylactic single dose administration and a 3-day course has been noted, but these studies are likely underpowered. [7][8][9][10] A longer course is probably warranted in men with risk factors. 11 Alternative choices to attempt to cover the common organisms E. coli, K. pneumoniae, P. aeruginosa and Enterococcus include another fluoroquinolone, a second or third generation cephalosporin or gentamicin.…”

Section: Discussionmentioning

confidence: 99%

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Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Toren

Razik

Trachtenberg

2013

CUAJ

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We report 2 cases of catastrophic complications following routine transrectal ultrasound guided prostate biopsy. The first patient incurred near-fatal septic shock due to multi-resistant Escherichia coli. Due to the severity of his shock, he developed bilateral leg gangrene requiring amputations. The second patient incurred significant hemorrhage eventually requiring an emergent general anesthesia and surgical management to control hemorrhage after other measures failed. While rare events, these reports emphasize the caution needed for physicians who routinely order prostate biopsies.Can Urol Assoc J 2010;4(1):E12-E14 Case 1A 63-year-old diabetic underwent transrectal ultrasound (TRUS)-guided prostate biopsy for an elevated PSA of 5.7 ng/mL and no findings on digital rectal examination (DRE). His past medical history included coronary bypass surgery, dyslipidemia and previous hospital admission for bronchitis. He smoked half a pack of cigarettes per day for 25 years.The day prior to his biopsy, he was initiated on ciprofloxacin 500 mg orally, 2 times a day. The night after his biopsy, he presented to the emergency room with a fever, chills, pain and breathlessness. He appeared septic, with a systolic blood pressure of 75 mmHg, temperature 39º C. Initial white blood count (WBC) was 1.1, with a critically low neutrophil count of 0.44. He was given fluids, ceftriaxone and flagyl in the emergency room. Subsequently, he was transferred to the intensive care unit (ICU) and started on ionotropes and empiric meropenem. He developed hypoxia and was intubated and sedated.During the first 4 days of admission, he continued to be unstable and hypotensive requiring ionotropic support and developing shock liver and renal failure. Solucortef and caspofungin were started; he also received a dose of amikacin. His WBC peaked at 42 on the fourth day of admission. Platelets remained very low at 21 and his international normalized ratio (INR) increased from normal to 2.13. Multi-resistant Escherichia coli was cultured from his blood and was initially only sensitive to amikacin, but eventually also found to be sensitive to meropenem.Against expectations, he survived and slowly recovered. A tracheostomy was performed, and he was eventually weaned off ventilation. As a result of his severe sepsis, he developed bilateral feet gangrene requiring bilateral below knee amputations. Further, he incurred ototoxicity requiring hearing aids. His thrombocytopenia, renal and liver failure resolved over time. He was in the ICU for a total of 46 days and in hospital for 85 days.His prostate biopsy did not show any evidence of malignancy. Case 2A 65-year-old pediatrician was sent for a TRUS biopsy of the prostate for a prostate-specific antigen (PSA) of 10.56 mg/L and a suspicious DRE. His medical history included coronary artery disease with previous coronary artery bypass grafting, hypertension and hypercholesterolemia. He had a mitral valve annuloplasty for mitral regurgitation. He experienced bleeding at the biopsy site immediately after ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Toren

Razik

Trachtenberg

2013

CUAJ

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“…Roach et al [16] in their randomised trial of ciprofloxacin and gentamicin found an incidence of bacteraemia and symptoms more in the gentamicin group. Gentamicin was found to be in lower concentrations in the prostatic tissue leading to 37% bacteraemia.…”

Section: Discussionmentioning

confidence: 99%

“…Comparisons were done between netilmicin + metronidazole versus trimethoprim + sulfamethoxazole [5] and ciprofloxacin versus gentamicin [16]. There have been studies in the literature with antibiotic combinations using amoxicillin and ß-lactamase inhibitor, potassium clavulanate [4].…”

Section: Introductionmentioning

confidence: 99%

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Trimethoprim versus Gentamicin for the Prevention of Bacteriuria following Transrectal Biopsy of the Prostate – Do Patients Need Additional Anaerobic Cover?

Shivde

Cooke²,

O’Neill³

et al. 2002

Urol Int

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Objectives: To study the incidence of aerobic and anaerobic bacteriuria in patients undergoing transrectal ultrasound-guided biopsies of the prostate. A comparative assessment of efficacy of trimethoprim with gentamicin for the prevention of bacteriuria following the transrectal biopsy of the prostate. To assess the need for additional prophylaxis against anaerobes for patients undergoing transrectal biopsies of the prostate gland. Patients and Methods: In a pilot study during 1995–1997, all the patients undergoing transrectal ultrasound-guided biopsy of the prostate were randomised to receive either trimethoprim or gentamicin prophylaxis prior to the procedure. Midstream urine (MSU) samples were taken just prior to biopsy and 72 h later. A patient questionnaire to determine the symptoms of urinary tract infection (UTI) accompanied the 72-hour MSU request form. Urine samples were cultured aerobically, using a semiquantitative technique if dipstick analysis revealed the presence of blood, pus cell or nitrite. In addition to the routine aerobic culture, post-biopsy samples were also cultured for anaerobes by direct and enrichment methods. Bacteriuria was defined as a pure or mixed growth of 10⁵ colony-forming units/ml. Fisher’s test of exact probability was used for statistical analysis. Results: 115 patients were available for final analysis. 53 had received gentamicin and 62 trimethoprim. Four patients had pre-existing bacteriuria (3.5%), 3 in the trimethoprim group and 1 in the gentamicin group. Post-operative bacteriuria developed in 5 patients given gentamicin (9.4%) and 1 given trimethoprim (1.6%). This difference was not statistically significant (p = 0.085). Post-procedure bacteriuria was asymptomatic in all but 1 case. Anaerobes were detected in only 5 MSUs (4.3%) post-biopsy. Conclusion: Though there was no statistical significant difference in the rates of bacteriuria following administration of trimethoprim and gentamicin, data appear to favour trimethoprim prophylaxis. Further studies are warranted. Transrectal biopsy of the prostate is associated with a low incidence of anaerobic UTI. In view of the very low incidence of anaerobic bacteriuria, routine antibacterial prophylaxis against anaerobes does not appear to be justified.

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Antibiotic prophylaxis for transrectal prostate biopsy

Zani¹,

Clark²,

Netto³

2007

Cochrane Database of Systematic Reviews

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Ciprofloxacin versus gentamicin in prophylaxis against bacteremia in transrectal prostate needle biopsy

Cited by 53 publications

References 10 publications

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Trimethoprim versus Gentamicin for the Prevention of Bacteriuria following Transrectal Biopsy of the Prostate – Do Patients Need Additional Anaerobic Cover?

Antibiotic prophylaxis for transrectal prostate biopsy

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