Impact of Rectal Swabs on Infectious Complications after Transrectal Prostate Biopsy

Trujillo, Carlos Gustavo; Plata, Mauricio; Caicedo, Juan Ignacio; Cataño, Juan Guillermo; Alvarez, A.M. Mariño; Castelblanco, Diana; Robledo, Daniela

doi:10.1159/000448595

Cited by 12 publications

(6 citation statements)

References 31 publications

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“…In our setting, the additional costs of culture-based prophylaxis were estimated to be €79. The efficiency will be higher in geographic regions with higher rates of ciprofloxacin resistance because of an increased event rate, which is generally the case outside The Netherlands [ 28 , 29 ]. Furthermore, in case of transperineal PB, more costs are involved as well as the procedure requires training of urologists and costly new biopsy devices.…”

Section: Discussionmentioning

confidence: 99%

Rectal Culture-Based Versus Empirical Antibiotic Prophylaxis to Prevent Infectious Complications in Men Undergoing Transrectal Prostate Biopsy: A Randomized, Nonblinded Multicenter Trial

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Kolwijck

Koldewijn

et al. 2022

Clinical Infectious Diseases

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Background An increase of infections after transrectal prostate biopsy (PB), related to an increasing number of patients with ciprofloxacin-resistant rectal flora, necessitates the exploration of alternatives for the traditionally standard used empirical prophylaxis with ciprofloxacin. We compared infectious complication rates after transrectal PB using empirical ciprofloxacin prophylaxis versus culture-based prophylaxis. Methods In this non-blinded, randomized trial, between April 4, 2018 to July 30, 2021, we enrolled 1538 patients from 11 Dutch hospitals undergoing transrectal PB. After rectal swab collection, patients were 1:1 randomized to receive empirical prophylaxis with oral ciprofloxacin (control group; CG), or culture-based prophylaxis (intervention group; IG). Primary outcome was any infectious complication within seven days post-biopsy. Secondary outcomes were infectious complications within 30 days, and bacteremia and bacteriuria within seven and 30 days post-biopsy. For primary outcome analysis, the Chi-square test stratified for hospital was used. Trial registration number: NCT03228108. Results Data from 1288 patients (83.7%) were available for analysis (CG: 652 and IG: 636). Infection rates within seven days post-biopsy were 4.3% (n = 28) (CG) and 2.5% (n = 16) (IG) (p-value: 0.08; reduction: -1.8%; 95% CI -0.004 to 0.040). Ciprofloxacin-resistant bacteria were detected in 15.2% (n = 1288). In the CG, the presence of ciprofloxacin-resistant rectal flora resulted in a 6.2 fold higher risk of early post-biopsy infection. Conclusions Our study supports the use of culture-based prophylaxis to reduce infectious complications after transrectal PB. Despite adequate prophylaxis, post-biopsy infections can still occur. Therefore, culture-based prophylaxis must be weighed against other strategies that could reduce post-biopsy infections.

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Section: Discussionmentioning

confidence: 99%

Rectal Culture-Based Versus Empirical Antibiotic Prophylaxis to Prevent Infectious Complications in Men Undergoing Transrectal Prostate Biopsy: A Randomized, Nonblinded Multicenter Trial

Tops

Kolwijck

Koldewijn

et al. 2022

Clinical Infectious Diseases

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“…In a similar study from Colombia, rectal swabs were used to determine the impact on infectious complications after transrectal biopsy. Of 548 men, 45.62% had FQ‐resistant bacteria, and hospital admissions due to infectious complications were reduced after the implementation of selective culture media before the prostate biopsy 56 . A Korean prospective multicenter study analyzed the prevalence of FQ‐resistant species in the rectal flora in patients undergoing a prostate biopsy.…”

Section: Screening Cultures Using Selective Mediamentioning

confidence: 99%

“…Of 548 men, 45.62% had FQresistant bacteria, and hospital admissions due to infectious complications were reduced after the implementation of selective culture media before the prostate biopsy. 56 A Korean prospective multicenter study analyzed the prevalence of FQresistant species in the rectal flora in patients undergoing a prostate biopsy. Using selective media, E. coli represented 81% of FQ-resistant bacteria.…”

Section: Screening Cultures Using Selective Media Overviewmentioning

confidence: 99%

Post‐prostate biopsy acute bacterial prostatitis and screening cultures using selective media: An overview

et al. 2022

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The development of several culture media and the availability to isolate and treat pathogens prior to a surgical procedure give us the ability to minimize treatmentrelated complications, and ultimately results in better outcomes for patients and avoidance of unwanted post-procedure inpatient admissions. In the last decade, an increasing incidence of multidrug-resistant Escherichia coli, especially extended-spectrum beta-lactamase-producing E. coli and fluoroquinolone-resistant pathogens, has been reported. These resistant species frequently colonize the rectal flora and gain access to the systemic circulation via the rectal plexus following a prostate biopsy. The bacteria can eventually lead to life-threatening complications, which is especially important in high-risk patients with multiple co-morbidities. Previously published studies have focused on the isolation of these pathogens with selective media before an invasive procedure and the potential benefits of incorporating the use of selective media as a mandatory pre-operative step. This preventive measure will allow us to offer a tailored prophylactic treatment that benefits patients and reduces the economic burden for the hospital.

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“…(1) Las bacterias que con mayor frecuencia se han relacionado a prostatitis e infecciones urinarias posteriores a biopsia son bacterias entéricas gram-negativas, en particular Escherichia coli. (2) Estas bacterias forman parte de la flora normal del recto y pueden generar resistencia antimicrobiana como consecuencia de uso previo de antibióticos, comorbilidades o viajes recientes.…”

Section: Antecedentesunclassified

Resistencia bacteriana en flora rectal previo a biopsia prostática en población mexicana

et al. 2021

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Resumen Antecedentes: El diagnóstico definitivo de cáncer de próstata se realiza mediante biopsia prostática. Aunque ha aumentado el abordaje transperineal, la biopsia transrectal sigue siendo la más utilizada a nivel mundial. Las complicaciones infecciosas son las más graves después de la biopsia. El uso de antimicrobianos como profilaxis es una práctica muy utilizada. Las fluoroquinolonas son los antibióticos de elección en todo el mundo previo a la realización de una biopsia. La resistencia antimicrobiana a las fluoroquinolonas ha aumentado en las últimas décadas. La resistencia muestra cifras muy variables en cada país y región. El uso de otras opciones de antibióticos dependerá de las sensibilidades locales. Objetivo: Conocer la prevalencia de resistencia bacteriana a fluoroquinolonas y otros antibióticos en los pacientes que acuden a realización de biopsia prostática en nuestro hospital. Materiales y métodos: Se realizó un hisopado rectal previo a biopsia prostática en pacientes que acudían a realización de biopsia transrectal de próstata. Se analizaron los resultados de los cultivos y se hizo un análisis descriptivo de las resistencias y sensibilidades encontradas. Resultados: Se realizaron 123 hisopados rectales. 89 pacientes tuvieron desarrollo en el cultivo. La principal bacteria fue E. coli. Encontramos resistencias en flora rectal previo a la biopsia a fluoroquinolonas del 83%. Los carbapenémicos muestran la mayor tasa de sensibilidad. No encontramos complicaciones infecciosas en nuestra población. Conclusión: Las resistencias a fluoroquinolonas en nuestra población es del 83%. El uso de antibiótico, preparación intestinal y un urocultivo previo, disminuyen la incidencia de infecciones posbiopsia. La biopsia transperineal ofrece la seguridad de ausencia de complicaciones infecciosas, sin embargo, lo pacientes muestran síntomas urinarios importantes con esta técnica. En nuestro país no existen reportes de resistencias bacterianas previos a biopsia transrectal.

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Impact of Rectal Swabs on Infectious Complications after Transrectal Prostate Biopsy

Cited by 12 publications

References 31 publications

Rectal Culture-Based Versus Empirical Antibiotic Prophylaxis to Prevent Infectious Complications in Men Undergoing Transrectal Prostate Biopsy: A Randomized, Nonblinded Multicenter Trial

Rectal Culture-Based Versus Empirical Antibiotic Prophylaxis to Prevent Infectious Complications in Men Undergoing Transrectal Prostate Biopsy: A Randomized, Nonblinded Multicenter Trial

Post‐prostate biopsy acute bacterial prostatitis and screening cultures using selective media: An overview

Resistencia bacteriana en flora rectal previo a biopsia prostática en población mexicana

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