Comparison of Single and Prolonged Fluoroquinolone Prophylaxis and Risk Factors for Infectious Complications After Transrectal Prostate Biopsy

Abstract

Background:The ideal prophylaxis duration for transrectal ultrasonography-guided prostate biopsy is incompletely defined.Aims:To compare the infectious complications of transrectal ultrasonography-guided prostate biopsy with and without extended antibiotic prophylaxis. The secondary aim was to evaluate the risk factors for infectious complications.Study Design:Prospective observational study.Methods:Four hundred patients who underwent transrectal ultrasonography-guided prostate biopsy were recruited. Patients orally received either 750 mg ciprofloxacin 60 min before the procedure or 500 mg ciprofloxacin twice a day for a duration of 7 days with the initial dose administered 24 h prior to the procedure. All patients were followed-up for 4 weeks after the transrectal ultrasonography-guided prostate biopsy procedure for infectious complications. Screening of urine was carried out in all patients on the 3rd and 7th day after the procedure. Medical histories of all patients were collected prior to biopsy. Information on medical history include the following: hospitalization, urethral catheterization, or urinary tract infections within the past 12 months; antibiotic use within the last 3 months, prior urinary tract interventions, and previous transrectal ultrasonography-guided prostate biopsy and Charlson comorbidity indexes. Ultrasound-guided biopsy was carried out using General Electric’s 7 MHz transrectal ultrasound device in the left decubitus position. Patients received one of the two ciprofloxacin-based prophylaxis regimens. Subsequent transrectal ultrasonography-guided prostate biopsy to all patients were followed-up for 30 days. Further follow-up of patients was carried out on the second and fourth weeks after transrectal ultrasonography-guided prostate biopsy, and symptoms, such as dysuria, rectal bleeding, fever, hematospermia, hematuria, and pollakiuria, were recorded.Results:Both groups presented similar baseline characteristics and medical history. Infectious complication rates within the 4-week follow-up were similar in both groups (single dose: 3% vs prolonged: 3%) (p>0.05). In both groups, infectious complications significantly increased than that at previous antibiotic usage (single: p=0.028; prolonged: p=0.040). Non-infectious complication ratios showed no significant variation (p>0.05).Conclusion:Pre-operative single dose of 750 mg oral ciprofloxacin compared with 7 days prolonged treatment resulted in similar infectious complication outcomes in patients undergoing transrectal ultrasonography-guided prostate biopsy. The use of antibiotics within the last 3 months increases the risk for post-transrectal ultrasonography-guided prostate biopsy infectious complications.

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

“…As recommended by the clinical practice guidelines in surgery, we routinely administer prophylactic preoperative antibiotics in all craniotomies [10]. While routine administration of postoperative antibiotics is common practice in many institutions, the risk of surgical site infection (SSI) remains unaffected [6,22,24,27,46].…”

<p>Retrospective Study of the Etiology and Risk Factors of Systemic Inflammatory Response Syndrome After Systematic Transrectal Ultrasound-Guided Prostate Biopsy</p>

“… 28 – 30 Unfortunately, in recent years, studies have found that the pathogenic bacteria Escherichia coli after TURS-PB resistance to quinolone antibiotics is as high as 80–90%. 29 , 31 , 32 In this study, we found that SIRS pathogens after TRUS-Bx showed strong resistance to levofloxacin, ciprofloxacin, gentamycin, penicillin G, compound Xinnuoming and the second-generation cephalosporins, with a resistance rate of 42.86%–80.95%. Therefore, we suggest that the preventive use of levofloxacin may need to be adjusted.…”

A novel enema method can prevent infectious complications of transrectal ultrasound‐guided prostate biopsy: A single‐centre experience

“…A nationwide study in Taiwan involving 12,968 TRUS‐bx procedures found that 6.59% of patients had infection complications and demonstrated that age, prostate cancer and hospitalisation were significant risk factors for severe infection 15 . Another study demonstrated that previous antibiotic usage within 3 months increased UTI development fater TRUS‐bx 23 . Elsewhere, a 10‐year case‐control investigation showed that infectious complications rose in the study period, and that recent hospitalisation, diabetes and chronic pulmonary obstructive disease from smoking were significant risk factors for infection 5 .…”

“…15 Another study demonstrated that previous antibiotic usage within 3 months increased UTI development fater TRUS-bx. 23 Elsewhere, a 10-year case-control investigation showed that infectious complications rose in the study period, and that recent hospitalisation, diabetes and chronic pulmonary obstructive disease from smoking were significant risk factors for infection. 5 Similarly, our study demonstrates that age, diabetes and prostate cancer are significantly higher in patients with postbiopsy UTI and the involvement of both diabetes and age are independent risk factors for biopsy-related infections of this kind.…”