Comparative Effectiveness of Single versus Combination Antibiotic Prophylaxis for Infections after Transrectal Prostate Biopsy

Abstract

An increase in fluoroquinolone resistance and transrectal ultrasound-guided prostate (TRUS) biopsy infections has prompted the need for alternative effective antibiotic prophylaxis. We aimed to compare ciprofloxacin and other single-agent therapies to combination therapy for efficacy and adverse effects. Men who underwent a TRUS biopsy within the VA Boston health care system with documented receipt of prophylactic antibiotics periprocedure were eligible for inclusion. Postprocedure infections within 30 days were ascertained by chart review from electronic records, including any inpatient, outpatient, or urgent-care visits. Among 455 evaluable men over a 3-year period, there were 25 infections (5.49%), with sepsis occurring in 2.4%, urinary tract infections (UTI) in 1.54%, and bacteremia in 0.44% of patients. Escherichia coli was the most common urine (89%) and blood (92%) pathogen, with fluoroquinolone resistance rates of 88% and 91%, respectively. Ciprofloxacin alone was associated with significantly more infections than ciprofloxacin plus an additional agent (P ‫؍‬ 0.014). Intramuscular gentamicin alone was also significantly associated with a higher infection rate obtained with all other regimens (P ‫؍‬ 0.004). Any single-agent regimen, including ciprofloxacin, ceftriaxone, or gentamicin, was associated with significantly higher infection rates than any combination regimen (odds ratio [OR], 4; 95% confidence interval [CI], 1.47, 10.85; P ‫؍‬ 0.004). Diabetes, immunosuppressive condition or medication, hospitalization within the previous year, and UTI within the previous 6 months were not associated with infection risk. Clostridium difficile infections were similar. These findings suggest that ciprofloxacin, ceftriaxone, and gentamicin alone are inferior to a combination regimen. Institutions with high failure rates of prophylaxis for TRUS biopsies should consider combination regimens derived from their local data.

Trial Comparing a Combined Regimen of Amikacin and Ciprofloxacin to Ciprofloxacin Alone as Transrectal Prostate Biopsy Prophylaxis in the Era of High Fluoroquinolone-Resistant Rectal Flora

“…This can be easily understood because broad spectrum antibiotics were used often during intensive surgery. These results regarding patient characteristics are not consistent with those of other studies, 16 24 and some considerations should be pondered to determine whether or not this risk factor is important prior to TRUSPB. Because western and European countries usually follow guidelines recommending single-dose prophylactic antibiotics in most surgeries, recent surgical history may not be a risk factor in these countries.…”

“…Marino et al 24 reported that single agents, such as ciprofloxacin, ceftriaxone, and gentamicin, alone are less effective than a combination regimen as prophylaxis for TRUSPB. In some studies, researchers argued that more intensive antibiotic regimens were needed to reduce the rate of complications.…”

The Rate of Urinary Tract Infections Following Transrectal Ultrasound-Guided Biopsy of Prostate in Babol, Northern Iran

“…in their study, Choi et al (19) Reported that 39 of 1195 (3.1%) Korean patients were infected after biopsy. Also, Marino et al (20) did a three-year study in the United States and declared that 25 of 455 (5.49%) patients reported UTI. Besides, Kandemir et al (21) In Turkey in 2016 stated a rate of 6.91% for UTI among 2215 patients underwent TRUS biopsy.…”

CombiANT: Antibiotic interaction testing made easy

“…Combinations of antibiotics are applied for up to 50% of patient cases in the treatment of severe surgical site infections, bacteremia, pneumonia, or septic shock [ 1 – 4 ]. Antibiotic combinations are also frequently prescribed as prophylactic treatments to prevent post-operation-related infections [ 5 , 6 ] and in the treatment of complicated chronic infections [ 7 – 9 ]. The rationale for combination therapy compared to monotherapy is 3-fold: (i) a broadened activity range by combining the different modes of action, pharmacodynamics, and pharmacokinetics of different antibiotics, (ii) stronger treatment effect, and (iii) reduced risk of resistance evolution.…”