Ertapenem prophylaxis reduces sepsis after transrectal biopsy of the prostate

Abstract

ObjectiveTo prospectively trial ertapenem prophylaxis in patients with known risk factors of sepsis undergoing transrectal biopsy of the prostate. Patients and MethodsIn this prospective audit, patients were identified as having a low-or high-risk of sepsis based on a questionnaire about established risk factors: previous biopsy; recurrent urine infections; receiving ciprofloxacin in the 12 months prior; travel to South-East Asia or South America in the previous 6 months; or diabetes, immune system impairment or receipt of immunosuppressant drugs.All received ciprofloxacin and amoxicillin-clavulanate and high-risk patients additionally received ertapenem.Sepsis requiring hospital admission was recorded.Data was analysed using a two-tailed Fisher's exact test. ResultsIn all, 80 men were identified as high risk of sepsis and 90 as low risk during the audit period.Six patients in the low-risk group (6.7%, 95% confidence interval 2.1-11.3) and none in the high-risk group developed sepsis (P = 0.03).Of the six developing sepsis, two grew ciprofloxacin-resistant organisms, two had no growth and two grew a ciprofloxacinsensitive organism, although one of these grew extendedspectrum β-lactamase-producing Escherichia coli. ConclusionThe addition of ertapenem to standard prophylaxis is effective at reducing sepsis after prostate biopsy.Risk stratification is not effective at identifying those men at low risk of sepsis, as these men still have a high sepsis rate.Ertapenem prophylaxis for all patients undergoing prostate biopsy is likely to be the most effective strategy in our population group.

Prevalence of fluoroquinolone‐resistant rectal flora in patients undergoing transrectal ultrasound‐guided prostate needle biopsy: A prospective multicenter study

“…Changing prophylactic antibiotic from FQ to some alternatives with low resistance rates in the rectal flora or extended antibiotic prophylaxis eliminates the need for rectal swab culture. Several studies using prophylactic antibiotics with amikacin, carbapenems and fosfomycin reported its successful use to reduce postbiopsy infectious complications …”

“…Several studies using prophylactic antibiotics with amikacin, carbapenems and fosfomycin reported its successful use to reduce postbiopsy infectious complications. [22][23][24] In addition to changing prophylactic antibiotics, several strategies have been suggested to reduce postbiopsy infectious complications. One such practice is rectal cleansing with enema, which could also improve ultrasonographic visualization of the prostate.…”

Does waiting after peri‐prostatic nerve block reduce pain during transrectal ultrasound‐guided prostate biopsy? A randomized controlled trial

“…All patients in this study received 1 g of intravenous ertapenem antibiotic prophylaxis as per the protocol at Wellington Hospital previously published. 17 PNB has no effect on pain from initial probe insertion into the rectum, which occurs prior to local anaesthetic infiltration. This has led to other authors investigating additional analgesic methods such as penthrox prior to probe insertion.…”

“…This may be a confounding factor and is a limitation of this study. All patients in this study received 1 g of intravenous ertapenem antibiotic prophylaxis as per the protocol at Wellington Hospital previously published …”

Ertapenem usage in cancer patients with and without neutropenia: a report on 97 cases from a comprehensive cancer center

“…Its in vitro activity includes coverage against Enterobacteriaceae that produce extended spectrum beta-lactamases (ESBLs), and fluoroquinolone resistant E. coli, organisms that are relatively common in this patient population [18,19]. Ertapenem has been used successfully for surgical prophylaxis in non-neutropenic cancer patients undergoing procedures such as intra-abdominal surgery, colo-rectal surgery, and transrectal biopsy of the prostate [20,22]. Our current study found that at our Comprehensive Cancer Center, ertapenem is being utilized for a number of indications other than surgical prophylaxis.…”