Performance Validation of Selective Screening Agars for Guiding Antimicrobial Prophylaxis in Patients Undergoing Prostate Biopsy

Abstract

A rectal culture-guided antimicrobial prophylaxis strategy may prevent infections after transrectal ultrasound-guided prostate biopsy (TRUSP). The use of selective culture media could assist the choice of appropriate antibiotic prophylaxis. The objective of our study was to evaluate the performance of four selective media used for guidance of oral antibiotic prophylaxis in TRUSP. In this prospective validation study, we used MacConkey media with vancomycin plus one of the following antibiotics: ciprofloxacin (McC3+CIP/V), trimethoprim (McC3+TMP/V), fosfomycin (McC3+FOF/V), and amdinocillin-amoxicillin-clavulanic acid (McC3+MEC/V). First, clinical strains of Gram-negative bacilli (GNB) ( = 33) were evaluated for growth on the selective media. Thereafter, rectal swabs ( = 97) were randomly collected from residual material of fresh stool samples and plated on a growth control and the four selective media. Levels of recovery of GNB on the growth control and selective media were compared, and the MICs of the antibiotics used in this study were determined. The sensitivity and specificity of the four selective media amounted, respectively, to 90.0% (55.5 to 99.8%) and 98.7% (93.1 to 100.0%) for McC3+CIP/V, 95.7% (85.2 to 99.5%) and 100.0% (91.6 to 100.0%) for McC3+TMP/V, 95.5% (84.5 to 99.4%) and 97.8% (88.2 to 99.9%) for McC3+FOF/V, and 100.0% (76.8 to 100.0%) and 97.6% (87.4 to 99.9%) for McC3+MEC/V. In conclusion, the four selective media were sufficiently sensitive and specific for the identification of rectal GNB resistant to ciprofloxacin, trimethoprim, fosfomycin, or amdinocillin-amoxicillin-clavulanic acid. These media can have added value in streamlining the optimal culture based antibiotic prophylaxis in TRUSP in a non-labor-intensive manner.

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

“…In case of infectious complications, this swab was used to provide information about the susceptibility of the rectal flora at the time of PB. See Supplementary File 2 for detailed information about the culture protocol [ 16 ].…”

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

“…Even higher results were reported by Tops et al . in 2018 (95.7% and 100% for sensitivity and specificity, respectively) 62 …”

“…27 Even higher results were reported by Tops et al in 2018 (95.7% and 100% for sensitivity and specificity, respectively). 62 The favorable tendencies among different studies highlight a promising future for further investigations and development to maximize the accuracy and efficacy of the selective media culture tools and techniques and ultimately incorporate the findings into general urologic practice (Table 2).…”

Surveillance and Stewardship: Where Infection Prevention and Antimicrobial Stewardship Intersect

“…This further delayed delivery of the results used for selecting a prophylaxis regimen and for performing the biopsies. Thus, some laboratories have taken a much broader approach to screening for resistant organisms using as many as 4 different selective agar media, containing either ciprofloxacin, fosfomycin, trimethoprim, or amdinocillin-amoxicillin-clavulanic acid, to identify the optimal agent for prophylaxis as rapidly as possible [ 23 ]. Although this approach is very effective in guiding selection of prophylaxis in a timely manner (all 4 media showed high sensitivity and specificity), the approach is very expensive and one that is simply untenable for many laboratories.…”