One preoperative dose randomized against 3‐day antibiotic prophylaxis for transrectal ultrasonography‐guided prostate biopsy

Briffaux, R.; Coloby, P.; Bruyère, F.; Ouaki, F.; Pirès, C.; Doré, B.; Irani, Jacques

doi:10.1111/j.1464-410x.2008.08128.x

Cited by 37 publications

(26 citation statements)

References 19 publications

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“…A recent multicenter study reported that 92.5% of the patients that underwent PB received FQ [5]. However, the duration of therapy is different in most studies [7,8]. …”

Section: Discussionmentioning

confidence: 99%

Impact of Rectal Swabs on Infectious Complications after Transrectal Prostate Biopsy

Trujillo

Plata²,

Caicedo³

et al. 2016

Urol Int

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Objectives: To determine the impact of rectal swabs (RSs) on infectious complications (IC) following prostate biopsy (PB). Methods: A retrospective cohort study was conducted including all patients subjected to PB between 2009 and 2013. Group B consisted of patients with a RS and group A of patients without. RS reported the presence of gram-positive or negative germs, sensitive or resistant to ciprofloxacin. Antimicrobial prophylaxis was adjusted to the result. Frequency of IC in each group was determined. Results: Group B had 548 (47.20%) patients and group A 613 (52.80%). From group B, 250 (45.62%) of the RSs showed fluoroquinolone (FQ)-resistant germs. Forty nine (16.44%) patients with sensitive germs vs. 147 (59.51%) with resistant germs had a history of previous FQ treatment (p < 0.0001). IC were observed in 33 (5.49%) patients from group A and in 7 (1.28%) patients from group B (p < 0.0001), requiring hospitalization in 4.99 vs. 1.28%, respectively. IC and hospital admissions were reduced in 76.68 and 74.34%, respectively, following the implementation of RS. Conclusions: RS and targeted antibiotic prophylaxis prior to PB was associated with a significant reduction in IC and hospital admissions. Ceftriaxone could be an alternative in cases of known resistance. Past history of FQ treatment is associated with increased resistance.

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“…A recent multicenter study reported that 92.5% of the patients that underwent PB received FQ [5]. However, the duration of therapy is different in most studies [7,8]. …”

Section: Discussionmentioning

confidence: 99%

Impact of Rectal Swabs on Infectious Complications after Transrectal Prostate Biopsy

Trujillo

Plata²,

Caicedo³

et al. 2016

Urol Int

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“…5 Nosocomial exposure and duration of the exposure to fluoroquinolones appear to be related to the incidence of resistance. [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.…”

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%

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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“…Recently, one of the main issues of concern has been the increasing resistance to antimicrobials of isolates from patients with sepsis following TRUSPB. Several publications have documented an alarming increase in resistance to fluoroquinolone among E. coli in post-TRUSPB infections [10,11], as well as to other antimicrobial agents such as ampicillin, ampicillin/sulbactam, trimethoprim/sulfamethoxazole and gentamicin [9,11]; extended spectrum β-lactamase (ESBL)-producing isolates have been increasingly recovered [12]. Over the years, there has been an increase of E. coli resistance to ciprofloxacin (up to 90%) accompanied by a concomitant increase in the rate of post-TRUSPB infectious complications [9,11].…”

Section: Introductionmentioning

confidence: 99%

The Value of Rectal Cultures in Treatment of Sepsis Following Post-Transrectal Ultrasound-Guided Prostate Biopsy

et al. 2015

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Background: Cases with sepsis after transrectal ultrasound-guided prostate biopsy (TRUSPB) were documented, with special focus on cultures and susceptibility of isolates. We also evaluated the contribution of concomitant rectal cultures to the treatment of selective cases. Materials and Methods: Patients with sepsis after TRUSPB were followed prospectively. Manifestations and risk factors for antimicrobial resistance were documented. Results of urine and blood cultures and antimicrobial susceptibility were recorded for all participating patients. In 40 patients, rectal swab cultures were obtained concomitantly. Results: Ninety-five patients were consecutively studied. Sepsis symptoms started showing up within 48 h after biopsy in 93% of patients. At least one of the cultures was positive in 72 patients. E. coli grew in 70 cases; isolates were highly resistant: 67% displayed multidrug-resistance. Rectal cultures grew E. coli in 38 cases. In patients with positive E. coli in rectum and in at least one additional culture (blood and/or urine), the antibiogram was identical in all cases but one. Eight cases had negative cultures. Conclusion: The prevalence of antimicrobial resistance among E. coli isolates from patients with TRUSPB sepsis was alarming. Susceptibilities of rectal E. coli isolates used for deescalation of initial empiric treatment in culture-negative TRUSPB sepsis can contribute to the reduction of broad-spectrum antibiotics exposure.

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One preoperative dose randomized against 3‐day antibiotic prophylaxis for transrectal ultrasonography‐guided prostate biopsy

Cited by 37 publications

References 19 publications

Impact of Rectal Swabs on Infectious Complications after Transrectal Prostate Biopsy

Impact of Rectal Swabs on Infectious Complications after Transrectal Prostate Biopsy

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

The Value of Rectal Cultures in Treatment of Sepsis Following Post-Transrectal Ultrasound-Guided Prostate Biopsy

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