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

Tops, Sofie C M; Kolwijck, Eva; Koldewijn, Evert L.; Somford, Diederik M.; Delaere, Filip J.M.; Leeuwen, Menno A. van; Breeuwsma, A.J.; Vocht, Thijn F. de; Broos, Hans J.H.P.; Schipper, R.A.; Steffens, M.G.; Teerenstra, Steven; Wegdam-Blans, Marjolijn C A; Brauwer, Els de; Bijllaardt, Wouter van den; Leenders, Alexander C. A. P.; Sedelaar, J Michiel P M; Wertheim, Heiman

doi:10.1093/cid/ciac913

Cited by 15 publications

(9 citation statements)

References 30 publications

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“…54 Rectal culture should be performed to avoid infective complications following the procedure and a targeted prophylactic treatment should be started. In the study of Tops et al 61 patients were divided in a control group (who took ciprofloxacin empirically) and in a treatment group (antibiotic choice was based on the preoperative rectal culture and antibiogram). Patients who underwent a rectal culture sample collection showed a statistically significant reduction in infectious complication rates when compared to empirically treated patients [OR 0.52, 95% CI 0.27-0.99].…”

Section: Prostate Biopsymentioning

confidence: 99%

Antibiotic prophylaxis in urologic interventions: Who, when, where?

Marino,

Rossi,

Murri

et al. 2024

Urologia

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Background: Periprocedural prophylaxis in medicine encompasses the set of measures (physical, chemical, and pharmacological) used to reduce the risk of infection. Antibiotic prophylaxis (AP) refers to the administration of a short-term regimen of antibiotics shortly before a medical procedure to reduce the risk of infectious complications that can result from diagnostic and therapeutic interventions. The outspreading growth of multidrug-resistant bacterial species and changes in the bacterial local ecosystem have impeded the development of a unique scheme of AP in urology. Objectives: To review the literature and current guidelines regarding AP for urological diagnostic and therapeutic procedures, and to define agents, timing, and occasions when administering pharmacological prophylaxis. Secondly, according to current literature, to open new scenarios where AP can be useful or useless. Results: Major gaps in evidence still exist in this field. AP appears useful in many invasive procedures and some sub-populations at risk of infectious complications. AP is not routinely recommended for urodynamic exams, diagnostic cystoscopy, and extracorporeal shock-wave lithotripsy. The available data regarding the use of AP during the transperineal prostate biopsy are still unclear; conversely, in the case of the transrectal approach AP is mandatory. AP is still considered the gold standard for the prevention of postoperative infective complications in the case of ureteroscopy, percutaneous nephrolithotomy, endoscopic resection of bladder tumor, endoscopic resection of the prostate, and prosthetic or major surgery. Conclusion: The review highlights the complexity of determining the appropriate candidates for AP, emphasizing the importance of considering patient-specific factors such as comorbidities, immunocompetence, and the nature of the urologic intervention. The evidence suggests that a one-size-fits-all approach may not be suitable, and a tailored strategy based on the specific procedure and patient characteristics is essential.

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Section: Prostate Biopsymentioning

confidence: 99%

Antibiotic prophylaxis in urologic interventions: Who, when, where?

Marino,

Rossi,

Murri

et al. 2024

Urologia

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“…Tops et al [52 ▪ ] conducted a large, sufficiently powered nonblinded RCT (n = 1288) in which patients undergoing TRPBs self-sampled a rectal swab (7–60days prior to procedure) and were then randomised to receive empirical prophylaxis (oral ciprofloxacin) as a control; or culture-based prophylaxis as the intervention. Infection rates as 7 days postbiopsy (primary outcome) were 4.3% for empirical therapy and 2.5% for culture-based therapy (Reduction: −1.8%; 95% CI, −0.004 to 0.040; P = 0.08).…”

Section: Urological Surgerymentioning

confidence: 99%

“…Five studies were identified [26,49,50,51 ▪▪ ,52 ▪ ] of which only two had greater than 500 participants [51 ▪▪ ,52 ▪ ].…”

Section: Urological Surgerymentioning

confidence: 99%

Surgical site infection prophylaxis: what have we learned and are we making progress?

Ierano,

Hall,

James

2023

Current Opinion in Infectious Diseases

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Purpose of review This review aims to discuss the current state of surgical antimicrobial prophylaxis (SAP) evidence for surgical site infection prevention. Despite decades of research, knowledge gaps persist in identifying optimal SAP regimens. Recent findings Recent randomised controlled trials highlight ongoing heterogeneity in study design. Key new findings support the use of oral preoperative SAP for colorectal surgery and advise against the use of SAP for transperineal prostate biopsy. There is growing evidence for culture-based SAP over empiric use for transrectal prostate biopsy. Contentious issues remain regarding topical antimicrobials for cardiac procedures involving sternotomy, the necessity of SAP for wire lumpectomy and laparoscopic cholecystectomy for both mild or moderate acute cholecystitis. Procedures where SAP is not indicated, yet research is still being conducted on this topic include dental implants and clean orthopaedic procedures. Summary Research efforts continue with numerous trials published and registered to determine optimal SAP regimens. However, many efforts are suboptimal due to poor statistical design and redundant questions already answered by existing literature. To improve practice and influence surgeons prescribing behaviour future RCTs should be well powered, with large sample sizes across multiple sites, focusing on clinically relevant questions.

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“…The application of MRI‐TBx might be restricted by some limitations (eg its high cost, complex operation, and limited availability). Although the combined biopsy added with MRI‐TBx improved the detection rate of PCa, complications (eg infection, pain, and bleeding) caused by added biopsy cores also increases 16,17 …”

mentioning

confidence: 99%

“…Although the combined biopsy added with MRI-TBx improved the detection rate of PCa, complications (eg infection, pain, and bleeding) caused by added biopsy cores also increases. 16,17 The aim of this study was to assess the diagnostic value of MRI-TBx compared to TRUS-SBx and combined biopsy and to further determine the effectiveness and accuracy of MRI-TBx based on PI-RADS v2.1 in TZ and PZ, respectively.…”

mentioning

confidence: 99%

Effectiveness and Accuracy of MRI‐Ultrasound Fusion Targeted Biopsy Based on PI‐RADS v2.1 Category in Transition/Peripheral Zone of the Prostate

Liu

Wang

et al. 2023

Magnetic Resonance Imaging

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Background MRI‐ultrasound fusion targeted biopsy (MRI‐TBx) improves the clinically significant prostate cancer (csPCa) detection with fewer cores. However, whether systematic biopsy‐guided by transrectal ultrasound (TRUS‐SBx) can be omitted when undergoing MRI‐TBx in transition zone (TZ) and peripheral zone (PZ) remains unclear. Purpose To assess the performance and effectiveness of MRI‐TBx based on PI‐RADS v2.1 for csPCa diagnosis in TZ and PZ, respectively. Study Type Retrospective. Subjects A total of 309 selected cases (median age 70 years) with 356 lesions who underwent both MRI‐TBx and TRUS‐SBx were enrolled. Field Strength/Sequence A 3.0 T, multiparametric MRI (mp‐MRI) including T2‐weighted turbo‐spin echo imaging (T2WI), diffusion‐weighted spin‐echo echo planar imaging (DWI), dynamic contrast‐enhanced MRI with time‐resolved T1‐weighted imaging (DCE). Assessment Mp‐MRI was assessed by two radiologists using PI‐RADS v2.1. The csPCa detection rates provided by MRI‐TBx, TRUS‐SBx and combined biopsy in TZ and PZ were calculated, respectively. Statistical Tests McNemar test was used to compare the csPCa detection rates in TZ and PZ, respectively. The frequencies and distribution of all detected prostate cancers by different biopsy methods were also compared. P < 0.05 was considered statistically significant. Results Among 356 lesions in 309 patients, 208 (68 in TZ, 140 in PZ) were pathologically confirmed as csPCa. In TZ, there were significant differences for csPCa detection with PI‐RADS 3 between combined biopsy and TRUS‐SBx (23.5% vs. 15.3%), MRI‐TBx (23.5% vs. 16.3%), respectively. MRI‐TBx detected 23% (19/83) cases missed by TRUS‐SBx in which 68% (13/19) were csPCa. In PZ, there were no statistical differences between MRI‐TBx and combined biopsy with PI‐RADS 3–5 (P = 0.21, 0.25, 0.07, respectively). In 9% (14/152) cases only detected by MRI‐TBx, 86% (12/14) were clinically significant. Five percent (7/152) of cases only detected by TRUS‐SBx were completely nonclinically significant. Data Conclusion MRI‐TBx played a positive role on csPCa diagnosis in TZ, but combined biopsy might be the best choice especially in the subgroup PI‐RADS 3. In PZ, MRI‐TBx had an advantage over TRUS‐SBx for csPCa detection. Evidence Level 2. Technical Efficacy Stage 2.

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

Cited by 15 publications

References 30 publications

Antibiotic prophylaxis in urologic interventions: Who, when, where?

Antibiotic prophylaxis in urologic interventions: Who, when, where?

Surgical site infection prophylaxis: what have we learned and are we making progress?

Effectiveness and Accuracy of MRI‐Ultrasound Fusion Targeted Biopsy Based on PI‐RADS v2.1 Category in Transition/Peripheral Zone of the Prostate

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