“Targeted” prophylaxis: Impact of rectal swab culture-directed prophylaxis on infectious complications after transrectal ultrasound-guided prostate biopsy

Prabhjot Singh; Ashish Kumar; Siddharth Yadav; Lok Prakash; Brusabhanu Nayak; Rajeev Kumar; Arti Kapil; Prem Nath Dogra

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자료유형: 학술저널

저자정보: Prabhjot Singh (All India Institute of Medical Sciences) Ashish Kumar (All India Institute of Medical Sciences) Siddharth Yadav (All India Institute of Medical Sciences) Lok Prakash (All India Institute of Medical Sciences) Brusabhanu Nayak (All India Institute of Medical Sciences) Rajeev Kumar (All India Institute of Medical Sciences) Arti Kapil (All India Institute of Medical Sciences) Prem Nath Dogra (All India Institute of Medical Sciences)

저널정보: 대한비뇨기과학회 Investigative and Clinical Urology Investigative and Clinical Urology Vol.58 No.5

발행연도: 2017.1

수록면: 365 - 370 (6page)

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Purpose: To assess the prevalence of fluoroquinolone resistance among patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy and the impact of rectal swab culture-directed antibiotic prophylaxis on postbiopsy infectious complications. Materials and Methods: We prospectively analyzed all patients undergoing TRUS-guided prostate biopsy from April 2013 to February 2015. Antibiotic prophylaxis was tailored to the results of rectal swab cultures. If the organism was fluoroquinolone-sensitive, oral ciprofloxacin 500 mg with tinidazole 600 mg was prescribed. If the organism was fluoroquinolone-resistant, then a culture-directed antibiotic was prescribed. In both cases the antibiotic was continued for 3 days. All patients were followed for 14 days after biopsy to record infectious complications. Results: A total of 247 patients were included, and Escherichia coli was isolated on rectal swab cultures in 99.5% of the patients. Of these, 41.7% harbored fluoroquinolone-resistant E. coli. Piperacillin/tazobactam was the most common culture-directed antibiotic prescribed (59.3%), with amoxicillin/clavulanic being the second most common (25.5%) for the fluoroquinolone-resistant group. Only 2 patients (0.9%) developed postbiopsy fever and none had sepsis. Conclusions: Colonization of rectal flora with fluoroquinolone-resistant E. coli was seen in 40% of men undergoing prostate biopsy. Targeted prophylaxis, which uses the results of prebiopsy rectal swab culture to direct antibiotic prophylaxis, results in low rates of postbiopsy infections.

참고문헌 (22)

참고문헌 신청

Williamson DA / 2013 / Infectious complications following transrectal ultrasound-guided prostate biopsy: new challenges in the era of multidrug-resistant Escherichia coli / Clin Infect Dis 57:267~274

Pinkhasov GI / 2012 / Complications following prostate needle biopsy requiring hospital admission or emergency department visits -experience from 1000 consecutive cases / BJU Int 110:369~374

Young JL / 2009 / Sepsis due to fluoroquinoloneresistant Escherichia coli after transrectal ultrasound-guided prostate needle biopsy / Urology 74:332~338

Lange D / 2009 / Bacterial sepsis after prostate biopsy--a new perspective / Urology 74:1200~1205

Carignan A / 2012 / Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis? / Eur Urol 62:453~459

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