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Jahnen M, Amiel T, Kirchoff F, Büchler JW, Herkommer K, Rothe K, Meissner VH, Gschwend JE, Lunger L. Cotrimoxazole and targeted antibiotic prophylaxis for transrectal prostate biopsy: a single-center study. World J Urol 2024; 42:260. [PMID: 38664275 PMCID: PMC11045637 DOI: 10.1007/s00345-024-04969-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE The recent restriction on the use of fluoroquinolones for prophylaxis by the European Commission has left a gap in clear recommendations for practical antibiotic prophylaxis (PAP) for transrectal prostate biopsy (TRPB). This analysis investigated the viability of cotrimoxazole for PAP in TRPB. METHODS This analysis included n = 697 patients who underwent TRPB for suspected prostate cancer (PCa). All patients received either empiric PAP with four doses of cotrimoxazole 960 mg or targeted antibiotic prophylaxis in case of a positive rectal or urine screening for multiresistant gram-negatives. Infectious complications after TRPB, microbiological findings, and clinical characteristics were evaluated. A multivariable logistic regression model was calculated to identify variables associated with infectious complications. RESULTS Of the cohort, 86% (600/697) received PAP with cotrimoxazole, 1% (8/697) received cotrimoxazole plus an additional antibiotic, 4% (28/697) received amoxicillin + clavulanic acid, 4% (28/697) received fluoroquinolones, and 5% (33/697) received a single shot intravenous antibiotic prophylaxis with meropenem or piperacillin + tazobactam due to multiresistant microbiological findings in either pre-interventional urine culture or rectal swab. Infectious complications occurred in 2.6% (18/697) of patients. Fever was noted in 89% (16/18) of cases. Inpatient treatment was given to 67% (12/18) of affected patients, with 38% (7/18) having positive blood cultures, identifying cotrimoxazole-resistant E. coli strains in six out of seven cases. Multivariable logistic regression analysis revealed no clinically significant variables, including PAP with cotrimoxazole, as independent risk factors for an infectious complication. CONCLUSIONS Using cotrimoxazole as PAP for TRPB in cases without multiresistant gram-negatives in pre-interventional urine cultures or rectal swabs seems feasible and practical.
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Affiliation(s)
- Matthias Jahnen
- Department of Urology, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Thomas Amiel
- Department of Urology, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian Kirchoff
- Department of Urology, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jacob W Büchler
- Department of Urology, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Valentin H Meissner
- Department of Urology, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lukas Lunger
- Department of Urology, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Shigemura K, Fujisawa M. Prevention and management of infectious complications in prostate biopsy: A review. Int J Urol 2021; 28:714-719. [PMID: 33966298 DOI: 10.1111/iju.14572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
Prostate biopsies are common procedures for urologists, performed in order to detect and diagnose prostate cancer. Procedures continue to evolve, for instance, recently there has been an increase in the use of the transperineal approach, and the emergence of antibiotic-resistant bacteria has become a challenge. This review examines the recent prostate biopsy literature as well as the guidelines of three urological associations. We review the recent literature, including our own recent studies, and the Japanese Urological Association, European Association of Urology and American Urological Association guidelines, and summarize the current recommendations regarding the prevention of infectious complications that can occur after prostate biopsy, including the use of antimicrobial agents, and the management and treatment of such complications. Current recommendations include single-dose or 1-day use of oral quinolones for infection control, along with consideration of high-risk patients with diabetes, steroid use, large prostates, or high residual urine volume for instance. Targeted therapies based on the results of rectal swabs carried out prior to transrectal prostate biopsy, which can provide better inhibitory data with regard to post-prostate biopsy infectious complications, can also be considered. In conclusion, oral quinolones for low-risk patients and targeted therapies for high-risk patients are recommended when using a transrectal approach to prostate biopsy, and oral quinolones are recommended when using a transperineal approach. Further randomized controlled trials are necessary to draw more definitive conclusions.
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Affiliation(s)
| | - Masato Fujisawa
- Department of Urology, Kobe University Hospital, Kobe, Hyogo, Japan
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Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions. Int Urol Nephrol 2018; 50:1923-1937. [DOI: 10.1007/s11255-018-1971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
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Baba K, Sekine Y, Miyazawa Y, Syuto T, Nomura M, Koike H, Matsui H, Shibata Y, Ito K, Suzuki K. Assessment of antimicrobiral prophylaxis in transperineal prostate biopsy: A single-center retrospective study of 485 cases. J Infect Chemother 2018; 24:637-640. [DOI: 10.1016/j.jiac.2018.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 10/28/2022]
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Hsu CK, Lin CD, Heish CH, Yang SD. Single dose quinolone prophylaxis for out-patient transrectal prostate biopsy: The first experience in Taiwan. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Nyongole O, Akoko L, Mwanga A, Mchembe M, Kamala B, Mbembati N. Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania. Pan Afr Med J 2015; 22:226. [PMID: 26952184 PMCID: PMC4761242 DOI: 10.11604/pamj.2015.22.226.6253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 10/20/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Antimicrobial prophylaxis for urologic procedures is a major issue, as potential advantages of antibiotic administration should be carefully weighed against potential side effects, microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic use in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third world environment. Methods This was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software. Results Male patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction. Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or treatment intention. Conclusion Antibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.
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Affiliation(s)
- Obadia Nyongole
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Larry Akoko
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Ally Mwanga
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Mabula Mchembe
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Benjamin Kamala
- Department of community Medicine, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Naboth Mbembati
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
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Yaghi MD, Kehinde EO. Oral antibiotics in trans-rectal prostate biopsy and its efficacy to reduce infectious complications: Systematic review. Urol Ann 2015; 7:417-27. [PMID: 26538868 PMCID: PMC4660689 DOI: 10.4103/0974-7796.164860] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/09/2015] [Indexed: 11/15/2022] Open
Abstract
For the diagnosis of prostate cancer trans-rectal prostate biopsy (TRPB) is used commonly, the procedure is associated with infective complications. There is evidence that antibiotics (ABx) decrease infective events after TRPB, but different regimens are used. To systematically review different regimens of prophylactic oral ABx in TRPB. MEDLINE, EMBASE, clinical trials site, and Cochrane library were searched, experts were consulted for relevant studies. Randomized clinical trials conducted in the last 20 years, which investigated the different oral antibiotic regimens in TRPB, and compared their efficacy to reduce infectious complications were analyzed. Primary outcomes were bacteriuria, urinary tract infection (UTI), fever, bacteremia, and sepsis. Secondary outcomes were the hospitalization rate and the prevalence of ABx-resistant bacteria. Nine trials were eligible with 3012 patients. ABx prevented bacteriuria (3.5% vs. 9.88%), UTI (4.46% vs. 9.75%), and hospitalization (0.21% vs. 2.13%) significantly in comparison with placebo or no treatment. No significant difference was found in all the outcomes of the review between the single dose regimen and the 3 days. The single dose regimen was as effective as the multiple doses except in bacteriuria (6.75% vs. 3.25%), and the prevalence of ABx-resistant bacteria (1.57% vs. 0.27%). Quinolones reduced only UTI significantly in comparison with other ABx (chloramphenicol, trimethoprim-sulfamethoxazol). It is essential to prescribe prophylactic ABx in TRPB. No conclusive evidence could be claimed about the superiority of the multiple or the 3 days regimens to the single dose regimen. Unexpectedly, ABx-resistant bacteria were identified more often in the single dose cohorts.
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Affiliation(s)
- Mohand Deeb Yaghi
- Ministry of Health in, Al-Jahra Health Region, Saad Al-Abdullah Specialized Medical Institute, Kuwait
| | - E. O. Kehinde
- Department of Surgery, Division of Urology, Ministry of Health, University, Kuwait
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Yang L, Gao L, Chen Y, Tang Z, Liu L, Han P, Zeng H, Li X, Wei Q. Prophylactic Antibiotics in Prostate Biopsy: A Meta-Analysis Based on Randomized Controlled Trials. Surg Infect (Larchmt) 2015; 16:733-47. [PMID: 26325245 DOI: 10.1089/sur.2015.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite frequent use of prophylactic antibiotics for patients undergoing transrectal prostate biopsy (TRPB), the incidences of urinary tract infection (UTI) and bacteria resistance are increasing. The aim of this study is to evaluate the current regimen of antimicrobial prophylaxis in TRPB. METHODS A systematic search of PubMed(®), Embase(®), and the Cochrane Library was performed to identify all randomized controlled trials (RCT) related to the effects of antibiotic prophylaxis for TRPB. The outcomes included bacteriuria, bacteremia, drug-resistant bacteria on urine/blood culture, fever, UTI, sepsis, and hospitalization. RESULTS A total of 22 RCTs with 3846 patients were identified and included. Nine trials analyzed antibiotics versus placebo/no treatment, with all outcomes substantially favoring antibiotic use (p<0.05), including bacteriuria (risk ratio [RR] 0.25, 95% confidence interval [CI] 0.15-0.42), bacteremia (RR 0.67, 95% CI 0.49-0.92), fever (RR 0.39, 95% CI 0.23-0.64), UTI (RR 0.37, 95% CI 0.22-0.62), and hospitalization (RR 0.13, 95% CI 0.03-0.55). There were no substantial differences between long-course versus short-course treatment and single versus multiple dose respectively, except for a greater risk of bacteriuria for short-course treatment (RR 2.09, 95% CI 1.17-3.73, p=0.01) and single-dose treatment (RR 1.98, 95% CI 1.18-3.33, p=0.01). There were no substantial differences among the groups for bacteriuria, fever, UTI, and hospitalization, when comparing oral versus systemic administration of antibiotics. The efficacy of several classes of antibiotics was compared without any difference among them. Despite the lack of significance, the synthesized data of three RCTs indicated a trend towards the use of combined antibiotics. CONCLUSIONS Prophylactic antibiotics could be beneficial for the reduction of infective complications after TRPB. Single-dose or short-course oral administration with any type of antibiotic appears to be optimal. One additional type of antibiotic added to the basic antibiotic agent may contribute to the minimization of severe infection and drug resistance.
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Affiliation(s)
- Lu Yang
- Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Liang Gao
- Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Yongji Chen
- Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Zhuang Tang
- Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Liangren Liu
- Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Ping Han
- Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Hao Zeng
- Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Xiang Li
- Department of Urology, West China Hospital, Sichuan University , Chengdu, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University , Chengdu, China
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Abstract
The essential value of antimicrobial prophylaxis is to defend the patient undergoing invasive diagnostic procedures or surgery against infectious complications by reducing the bacterial load. Escherichia coli remains the predominant uropathogen (70-80%) isolated in acute community-acquired uncomplicated infections, followed by Staphylococcus saprophyticus (10 to 15%). Klebsiella, Enterobacter, Proteus species, and enterococci infrequently cause uncomplicated cystitis and pyelonephritis. The pathogens traditionally associated with UTI are altering many of their features, particularly because of antimicrobial resistance. Currently, only transurethral resection of prostate and prostate biopsy has been well studied and has high and moderately high levels of evidence in favor of using antibiotic prophylaxis. Other urological interventions have not been well studied. The moderate to low evidence suggests that there is no need for antibiotic prophylaxis in cystoscopy, urodynamic investigations, and extracorporeal shock-wave lithotripsy, whereas the low evidence favors the use of antibiotic prophylaxis for therapeutic ureterorenoscopy and percutaneous nephrolithotomy. The scarce data from studies on transurethral resection of bladder tumors cannot provide a definitive indication for antibiotic prophylaxis for this intervention.
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[Antibiotic prophylaxis in urology]. Urologia 2014; 81:209-17. [PMID: 25532466 DOI: 10.5301/uro.5000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Antibiotic prophylaxis (AP) is used to minimize infectious complications resulting from interventions. Due to high rates of development of bacterial resistance and side effects, the use of antibiotics must be weighed on the basis of high levels of evidence. The main endpoints of urology AP are the prevention of symptomatic urogenital infections, urosepsis and wound infections. The purpose of this review is to bring objectives, principles and recommendations on urology AP according to the latest scientific evidence. METHODS We carried out a systematic search of MEDLINE, EMBASE and the Cochrane Library using keywords such as AP, prophylaxis, antibiotics, urological surgery, urogenital surgery and the names of the urologic procedures. The results of studies on the AP for each procedure were classified according to the levels of evidence and grades of recommendation from the European Association of Urology. RESULTS There are a number of good quality studies on AP about endoscopic resection of the prostate (TURP), urodynamic studies and transrectal prostate biopsies (trPB). The majority of the studies about other procedures have several limitations (sample size, consistency of definitions, statistics and trial design). Lack of consistency in the definitions of infectious complications does not allow comparison between different studies. CONCLUSIONS The AP is evidence-based is indicated only for TURP and trPB. It is desirable to perform randomized, prospective and controlled trials in order to rationalize the use of antibiotics, improve the cost/benefit ratio and reduce bacterial antibiotic resistances.
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Abstract
There are specific indications in urological procedures [transurethral resection of the prostate (TURP), transurethral resection of the bladder (TURB), endoscopic procedures, and all interventions classified as contaminated or dirty] requiring antibiotic prophylaxis. Most postoperative infections are caused by enterococci of the Gram-positive strains and Enterobacteriaceae of the Gram-negative ones. As reported by the European Center for Disease Prevention and Control (ECDC), there are increasing numbers of antibiotic-resistant pathogens. Most Enterococcus faecium strains are ampicillin-resistant and the Enterobacteriaceae have a high prevalence of extended-spectrum beta-lactamase (ESBL) producers, for which the cephalosporins and penicillins are not drugs of choice. In recent years, there are also increasing numbers of Gram-negative strains that are able to produce carbapenemases and for which the only therapeutic options are gentamicin, tigecycline and colistin. An alternative to these drugs, from a prophylactic point of view, is fosfomycin, an old antibiotic that maintains bactericidal activity against both enterococci and multidrug-resistant Enterobacteriaceae. Available in an oral formulation as trometamol salt, fosfomycin reaches high plasma and urine concentrations, and is therefore a possible alternative to other drugs both for therapy and urological prophylaxis.
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Campeggi A, Ouzaid I, Xylinas E, Lesprit P, Hoznek A, Vordos D, Abbou CC, Salomon L, de la Taille A. Acute bacterial prostatitis after transrectal ultrasound-guided prostate biopsy: Epidemiological, bacteria and treatment patterns from a 4-year prospective study. Int J Urol 2013; 21:152-5. [DOI: 10.1111/iju.12207] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/24/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Alexandre Campeggi
- Department of Urology; Henri Mondor Hospital; AP-HP; Paris-Est University; Créteil France
| | - Idir Ouzaid
- Department of Urology; Henri Mondor Hospital; AP-HP; Paris-Est University; Créteil France
| | - Evanguelos Xylinas
- Department of Urology; Henri Mondor Hospital; AP-HP; Paris-Est University; Créteil France
| | - Philippe Lesprit
- Department of Infection Prevention Unit; Henri Mondor Hospital; AP-HP; Paris-Est University; Créteil France
| | - Andras Hoznek
- Department of Urology; Henri Mondor Hospital; AP-HP; Paris-Est University; Créteil France
| | - Dimitri Vordos
- Department of Urology; Henri Mondor Hospital; AP-HP; Paris-Est University; Créteil France
| | - Claude-Clément Abbou
- Department of Urology; Henri Mondor Hospital; AP-HP; Paris-Est University; Créteil France
| | - Laurent Salomon
- Department of Urology; Henri Mondor Hospital; AP-HP; Paris-Est University; Créteil France
| | - Alexandre de la Taille
- Department of Urology; Henri Mondor Hospital; AP-HP; Paris-Est University; Créteil France
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Lugg J, Lettieri J, Stass H, Agarwal V. Determination of the Concentration of Ciprofloxacin in Prostate Tissue Following Administration of a Single, 1000 mg, Extended-Release Dose. J Chemother 2013; 20:213-8. [DOI: 10.1179/joc.2008.20.2.213] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 685] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Duplessis CA. Reply. Urology 2012. [DOI: 10.1016/j.urology.2011.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Siriboon S, Tiengrim S, Taweemongkongsup T, Thamlikitkul V, Chayakulkeeree M. Prevalence of Antibiotic Resistance in Fecal Flora of Patients Undergoing Transrectal Ultrasound-Guided Prostate Biopsy in Thailand. Urol Int 2012; 88:187-93. [DOI: 10.1159/000335506] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 12/02/2011] [Indexed: 11/19/2022]
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Grabe M. Antibiotic prophylaxis in urological surgery, a European viewpoint. Int J Antimicrob Agents 2011; 38 Suppl:58-63. [DOI: 10.1016/j.ijantimicag.2011.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Madden T, Doble A, Aliyu SH, Neal DE. Infective complications after transrectal ultrasound-guided prostate biopsy following a new protocol for antibiotic prophylaxis aimed at reducing hospital-acquired infections. BJU Int 2011; 108:1597-602. [DOI: 10.1111/j.1464-410x.2011.10160.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Transrectal prostate biopsy (TRPB) is a well established procedure used to obtain tissue for the histological diagnosis of carcinoma of the prostate. Despite the fact that TRPB is generally considered a safe procedure, it may be accompanied by traumatic and infective complications, including asymptomatic bacteriuria (bacteria in the urine), urinary tract infection (UTI), transitory bacteremia (bacteria in the blood), fever episodes, and sepsis (pathogenic microorganisms or their toxins in the blood). Although infective complications after TRPB are well known, there is uncertainty about the necessity and effectiveness of routine prophylactic antibiotics and their adverse effects, as well as a clear lack of standardization. OBJECTIVES To evaluate the effectiveness and adverse effects of prophylactic antibiotic treatment in TRPB. SEARCH STRATEGY The search covered the principal electronic databases: MEDLINE, EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL). Experts were consulted and references from the relevant articles were scanned. SELECTION CRITERIA All randomized, controlled trials (RCTs) of men who underwent TRPB and received prophylactic antibiotics or placebo/no treatment, were selected, and all RCTs looking at one type of antibiotic versus another, including comparable dosages, routes of administration, frequency of administration, and duration of antibiotic treatment. DATA COLLECTION AND ANALYSIS Two reviewers (ELZ, OACC) independently selected included trials and extracted study data. Any disagreements were resolved by a third party (NRNJ). MAIN RESULTS Overall, more than 3500 references were considered and 19 original reports with a total of 3599 patients were included.There were 9 trials analysing antibiotics versus placebo/no treatment, with all outcomes significantly favouring antibiotic use (P < 0.05) (I(2) = 0%), including bacteriuria (risk ratio (RR) 0.25 (95% confidence interval (CI) 0.15 to 0.42), bacteremia (RR 0.67, 95% CI 0.49 to 0.92), fever (RR 0.39, 95% CI 0.23 to 0.64), urinary tract infection (RR 0.37, 95% CI 0.22 to 0.62), and hospitalization (RR 0.13, 95% CI 0.03 to 0.55). Several classes of antibiotics were effective prophylactically for TRPB, while the quinolones, with the highest number of studies (5) and patients (1188), were the best analysed. For 'antibiotics versus enema', we analysed four studies with a limited number of patients. The differences between groups for all outcomes were not significant. For 'antibiotic versus antibiotic + enema', only the risk of bacteremia (RR 0.25, 95% CI 0.08 to 0.75) was diminished in the 'antibiotic + enema group'. Seven trials reported the effects of short-course (1 day) versus long-course (3 days) antibiotics. Long course was significantly better than short-course treatment only for bacteriuria (RR 2.09, 95% CI 1.17 to 3.73). For 'single versus multiple dose', there was significantly greater risk of bacteriuria for single-dose treatment (RR 1.98, 95% CI 1.18 to 3.33). Comparing oral versus systemic administration - intramuscular injection (IM), or intravenous (IV) - of antibiotics, there were no significant differences in the groups for bacteriuria, fever, UTI and hospitalization. AUTHORS' CONCLUSIONS Antibiotic prophylaxis is effective in preventing infectious complications following TRPB. There is no definitive data to confirm that antibiotics for long-course (3 days) are superior to short-course treatments (1 day), or that multiple-dose treatment is superior to single-dose.
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Affiliation(s)
- Emerson L Zani
- State University of Campinas (UNICAMP), Av. Bosque da Saude, 655, Apto 153, São Paulo, São Paulo, Brazil, 04142-091
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Gurbuz C, Canat L, Atis G, Caskurlu T. Reducing infectious complications after transrectal prostate needle biopsy using a disposable needle guide: is it possible? Int Braz J Urol 2011; 37:79-84;discussion 85-6. [DOI: 10.1590/s1677-55382011000100010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2010] [Indexed: 11/21/2022] Open
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Hori S, Sengupta A, Joannides A, Balogun-Ojuri B, Tilley R, McLoughlin J. Changing antibiotic prophylaxis for transrectal ultrasound-guided prostate biopsies: are we putting our patients at risk? BJU Int 2010; 106:1298-302; discussion 1302. [DOI: 10.1111/j.1464-410x.2010.09416.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Serretta V, Catanese A, Ruggirello A, Scuto F, Melloni D. Antibiotic Prophylaxis in Prostate Biopsy. Urologia 2010. [DOI: 10.1177/039156031007700102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Prostate biopsy is nowadays one of the most frequent diagnostic procedures in urology. The incidence of bacteraemia, bacteriuria and infective complications is higher after the transrectal procedure than after the transperineal one. A survey demonstrated that 98% of the urologists in USA use antibiotics to prevent infective complications. The transrectal prostate biopsy is the only diagnostic intervention procedure in urology for which an antibiotic prophylaxis is recommended, also for low-risk patients, by the guidelines of the European Association of Urology. If the perineal route is adopted, the antibiotic prophylaxis is recommended only in high-risk patients. Materials and Methods The patient should preferably receive an evacuative enema to achieve a rectal cleansing and to ameliorate the diagnostic accuracy of transrectal ultrasound. A survey in the US demonstrated that an evacuative enema with saline solution is adopted by more than 80% of urologists. Criteria for antibiotics choice. The majority of bacteraemias are transitory, asymptomatic and self-limiting. On the other side, bacteriuria can persist for several days. Antibiotics must achieve high drug concentrations not only in plasma and tissue but also in urine. Symptomatic infections are generally caused by E. Coli and less frequently by the Streptococcus faecalis. Nevertheless, other agents as Klebsiella and Chlostridium, although rare, might cause severe infections. Thus, prophylaxis needs antibiotics at large spectrum and a single agent may not be enough for high-risk patients. Risk determination and drug schedules. It is essential to point out the infective risk of the patient. The choice of the drug, the timing and schedule of antibiotic prophylaxis are still object of debate. Several randomized studies have been conducted with contradictory results. Results The antibiotic prophylaxis should be tailored according to patients’ infective risk and to the procedure adopted. It is able to reduce infections rate after transrectal biopsy below 5%. The adoption of periprostatic anesthesia and the number of cores can influence the incidence of infective complications. Commonly, one-three days oral administration of fluoroquinolone is adopted. A single-dose prophylaxis can be also used with favorable results. Tolerability and route of administration should be taken into account, and also costs should be considered. Conclusions Considering the low cost of antibiotics adopted as short-term prophylaxis and the high cost of the treatment of infective complications, it seems reasonable to provide antibiotics prophylaxis for all patients at high risk for infective complications and for all cases submitted to transrectal prostate biopsy.
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Affiliation(s)
- V. Serretta
- Dipartimento di Medicina Interna Malattie Cardiovascolari e Nefrourologiche; Sezione di Urologia, Università degli Studi di Palermo
| | - A. Catanese
- Dipartimento di Medicina Interna Malattie Cardiovascolari e Nefrourologiche; Sezione di Urologia, Università degli Studi di Palermo
| | - A. Ruggirello
- Dipartimento di Medicina Interna Malattie Cardiovascolari e Nefrourologiche; Sezione di Urologia, Università degli Studi di Palermo
| | - F. Scuto
- Dipartimento di Medicina Interna Malattie Cardiovascolari e Nefrourologiche; Sezione di Urologia, Università degli Studi di Palermo
| | - D. Melloni
- Dipartimento di Medicina Interna Malattie Cardiovascolari e Nefrourologiche; Sezione di Urologia, Università degli Studi di Palermo
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Bacterial Sepsis After Prostate Biopsy—A New Perspective. Urology 2009; 74:1200-5. [DOI: 10.1016/j.urology.2009.07.1222] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 07/09/2009] [Accepted: 07/10/2009] [Indexed: 11/17/2022]
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Young JL, Liss MA, Szabo RJ. Sepsis Due to Fluoroquinolone-resistant Escherichia coli After Transrectal Ultrasound-guided Prostate Needle Biopsy. Urology 2009; 74:332-8. [DOI: 10.1016/j.urology.2008.12.078] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Revised: 12/15/2008] [Accepted: 12/18/2008] [Indexed: 10/20/2022]
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Briffaux R, Merlet B, Normand G, Coloby P, Leremboure H, Bruyère F, Pires C, Ouaki F, Doré B, Irani J. Antibioprophylaxie courte versus longue pour les biopsies prostatiques. Étude prospective randomisée multicentrique. Prog Urol 2009; 19:39-46. [PMID: 19135641 DOI: 10.1016/j.purol.2008.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 06/19/2008] [Accepted: 08/01/2008] [Indexed: 11/30/2022]
Affiliation(s)
- R Briffaux
- Service d'urologie, CHU La Miléterie, 2, rue de la Miléterie, 86021 Poitiers cedex, France.
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Yamamoto S, Ishitoya S, Segawa T, Kamoto T, Okumura K, Ogawa O. Antibiotic prophylaxis for transrectal prostate biopsy: A prospective randomized study of tosufloxacin versus levofloxacin. Int J Urol 2008; 15:604-6. [DOI: 10.1111/j.1442-2042.2008.02056.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tuncel A, Aslan Y, Sezgin T, Aydin O, Tekdogan U, Atan A. Does Disposable Needle Guide Minimize Infectious Complications After Transrectal Prostate Needle Biopsy? Urology 2008; 71:1024-7; discussion 1027-8. [DOI: 10.1016/j.urology.2007.11.160] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 11/22/2007] [Accepted: 11/27/2007] [Indexed: 10/22/2022]
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Bootsma AMJ, Laguna Pes MP, Geerlings SE, Goossens A. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol 2008; 54:1270-86. [PMID: 18423974 DOI: 10.1016/j.eururo.2008.03.033] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 03/11/2008] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Antibiotic prophylaxis is used to minimize infectious complications resulting from interventions. Side-effects and development of microbial resistance patterns are risks of the use of antibiotics. Therefore, the use should be well considered and based on high levels of evidence. In this review, all available evidence on the use of antibiotic prophylaxis in urology is gathered, assessed, and presented in order to make choices in the use of antibiotic prophylaxis on the best evidence currently available. METHODS A systematic literature review was conducted, searching Medline, Embase (1980-2006), the Cochrane Library, and reference lists for relevant studies. All selected articles were reviewed independently by two, and, in case of discordance, three, reviewers. RESULTS Only the transurethral resection of prostate (TURP) and prostate biopsy are well studied and have a high and moderate to high level of evidence in favour of using antibiotic prophylaxis. Other urologic interventions are not well studied. The moderate to low evidence suggests no need for antibiotic prophylaxis in cystoscopy, urodynamic investigation, transurethral resection of bladder tumor, and extracorporeal shock-wave lithotripsy, whereas for therapeutic ureterorenoscopy and percutaneous nephrolithotomy, the low evidence favours the use of antibiotic prophylaxis. Urologic open and laparoscopic interventions were classified according to surgical wound classification, since no studies were identified. Antibiotic prophylaxis is not advised in clean surgery, but is advised in clean-contaminated and prosthetic surgery. CONCLUSIONS Except for the TURP and prostate biopsy, there is a lack of well-performed studies investigating the need for antibiotic prophylaxis in urologic interventions.
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Affiliation(s)
- A M Jikke Bootsma
- Department of Urology, Academic Medical Center, University of Amsterdam, The Netherlands
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Stoica G, Cariou G, Colau A, Cortesse A, Hoffmann P, Schaetz A, Sellam R. Epidémiologie et traitement des prostatites aiguës après biopsie prostatique. Prog Urol 2007; 17:960-3. [DOI: 10.1016/s1166-7087(07)92397-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Argyropoulos AN, Doumas K, Farmakis A, Liakatas I, Gkialas I, Lykourinas M. Time of administration of a single dose of oral levofloxacin and its effect in infectious complications from transrectal prostate biopsy. Int Urol Nephrol 2007; 39:897-903. [PMID: 17203352 DOI: 10.1007/s11255-006-9112-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 09/13/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of two prophylactic schemes for prostate biopsy using a single dose of oral levofloxacin given either before, or immediately after transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS A total of 300 men formed two groups of 150 patients each: the first group received one dose of 500 mg of levofloxacin 30 min to an hour before, and the second group the same antibiotic immediately after prostate biopsy. No pre-biopsy enema was used. Side effects after prostate biopsy were recorded, and the two groups were compared. RESULTS Only one patient from the first group developed a urinary tract infection after biopsy. A mean number of more than 10 cores per patient were taken. Haematuria was the most common complaint, followed by haemospermia. Haematuria and rectal bleeding were more common in patients where more than 8 cores were taken from the prostate (P = 0.005 and P = 0.017, respectively). Prostate cancer was detected in 34.3% of patients in total. CONCLUSION The use of a single dose of 500 mg levofloxacin given immediately after prostate biopsy proved to be quite effective for the prevention of infectious complications, even in the setting of an extensive biopsy protocol.
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Affiliation(s)
- Athanasios N Argyropoulos
- Department of Urology, Athens General Hospital G. GENNIMATAS, Mesogion avenue, 11527, Athens, Greece.
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Lindstedt S, Lindström U, Ljunggren E, Wullt B, Grabe M. Single-Dose Antibiotic Prophylaxis in Core Prostate Biopsy: Impact of Timing and Identification of Risk Factors. Eur Urol 2006; 50:832-7. [PMID: 16750292 DOI: 10.1016/j.eururo.2006.05.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Accepted: 05/03/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess the level of infectious complications and the impact of timing of a single, prophylactic, oral dose of ciprofloxacin 750 mg given either 2 hours before or in conjunction with ultrasound-guided core biopsy of the prostate in men without recognised risk factors and to analyse potential risk factors. METHODS All men undergoing prostate biopsy for elevated prostate specific antigen or clinical suspected prostate cancer were enrolled in an open, comparative prospective study. Excluded were men with recognised risk factors for infective complications. Two end points were chosen: febrile genitourinary infection and the results of postbiopsy urine culture. RESULTS A total of 1322 prostate biopsy occasions were made in 1157 men. Twelve (0.9%) cases of febrile genitourinary infections were recorded, two of which had proven sepsis. Administrating the drug 2 hours before or at the time of biopsy (p > 0.5) showed no statistical difference. Eight of 12 patients were shown to have prebiopsy undisclosed risk factors. Four percent developed postbiopsy, asymptomatic, significant bacteriuria. In addition, three (27%) men with prebiopsy unrecognised bacteriuria, who were accidentally enrolled, developed febrile genitourinary infection; one had proven sepsis. CONCLUSIONS A single high-dose of oral ciprofloxacin 750 mg can be administered in direct conjunction with prostate biopsy to men without recognised risk factors, keeping the infection rate at approximately 1%. Bacteriuria before biopsy is a major risk factor for infective complications. Attention given to recognising individual risk factors would reduce the risk of infection further.
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Affiliation(s)
- Sandra Lindstedt
- Department of Urology, Malmö University Hospital, University of Lund, Malmö, Sweden
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Acimovic M, Tulic C, Dzamic Z, Radosavljevic R, Filimonovic J, Jovanovic M, Mitrovic D, Govedarevic V, Hadzi-Djokic J. Standardization of transrectal ultrasound-guided biopsy. ACTA ACUST UNITED AC 2006; 52:41-4. [PMID: 16673593 DOI: 10.2298/aci0504041a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ultrasound-guided biopsy is more sensitive to biopsy performed under the digital control, because 29% of prostatic cancers are not palpable. On the other hand, at least 30% of cancers are isoechogenic, so they cannot be viewed by transrectal ultrasound examination. It means that target biopsy is not sufficient for diagnosis of localized prostatic cancer, i.e., randomized samples are needed as well. More than ten years ago, the technique of sampling the six specimens became a standard procedure to which previously harvested target specimens from suspected growths were added. Today, the expansion of biopsy protocol is recommended, by obtaining the additional specimens from peripheral lateral area, four plus two samples if the prostate has volume over 50 ml. Larger number of biopsies requires anesthesia. In order to reduce complication, the cleaning of rectal ampulla and prophylactic use of quinolone are suggested.
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Affiliation(s)
- M Acimovic
- Istitute of Urology and Nephrology, Clinical Center of Serbia, Belgrade
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35
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Schaeffer EM. Prophylactic use of antimicrobials in commonly performed outpatient urologic procedures. ACTA ACUST UNITED AC 2006; 3:24-31. [PMID: 16474491 DOI: 10.1038/ncpuro0357] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 09/28/2005] [Indexed: 11/08/2022]
Abstract
An antimicrobial is an agent capable of killing or inhibiting the growth of a micro-organism. Antimicrobial prophylaxis encompasses efforts to prevent postprocedure infections through the use of an antimicrobial agent before, and, in some cases, for a limited time after a procedure. A thorough history and physical examination are essential to identify host factors that increase a patient's risk for postprocedural infection. Risk-modifying factors include age, anatomy, geographical area of residence, immune and nutritional status, cardiac valve integrity, prosthetic joints, the presence of indwelling hardware and distant infectious wounds. Prophylaxis for the most common urologic outpatient procedures can be attained with oral trimethoprim-sulfamethoxazole or fluoroquinolone administered between 2 h and 30 min before a procedure. Special consideration for the type and duration of prophylaxis should be given to patients with moderate to severe cardiac valvular conditions and recently inserted prosthetic joints.
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Affiliation(s)
- Edward M Schaeffer
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD 21287-2101, USA.
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Shigemura K, Tanaka K, Yasuda M, Ishihara S, Muratani T, Deguchi T, Matsumoto T, Kamidono S, Nakano Y, Arakawa S, Fujisawa M. Efficacy of 1-day prophylaxis medication with fluoroquinolone for prostate biopsy. World J Urol 2005; 23:356-60. [PMID: 16254727 DOI: 10.1007/s00345-005-0024-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 07/20/2005] [Indexed: 10/25/2022] Open
Abstract
A prospective, randomized trial in which 236 patients received oral levofloxacin, either at 600 mg/day for 1 day (n = 124) or 300 mg/day for 3 days (n = 112). Urinalysis, plasma white blood cell count (WBC) (per mm3), and C reactive protein (CRP) (mg/dl) levels were checked before prostate biopsy (PBX), on the day after PBX, and on the seventh day after PBX. Two patients (1.61%) who received 600 mg for 1 day and 2 patients (1.79%) who received 300 mg for 3 days had febrile infectious complications. There was no statistically significant difference between levofloxacin at 600 mg for 1 day and levofloxacin at 300 mg for 3 days regarding the elevation of WBC and CRP. We can perform PBX safely with levofloxacin at 600 mg for 1 day as prophylaxis and recommend this method from the point of view of the decrease of antibiotic-resistant strains.
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Affiliation(s)
- Katsumi Shigemura
- Division of Urology, Department of Organs Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan
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Kuzu MA, Hazinedaroğlu S, Dolalan S, Ozkan N, Yalçin S, Erkek AB, Mahmoudi H, Tüzüner A, Elhan AH, Kuterdem E. Prevention of Surgical Site Infection After Open Prosthetic Inguinal Hernia Repair: Efficacy of Parenteral Versus Oral Prophylaxis with Amoxicillin-Clavulanic Acid in a Randomized Clinical Trial. World J Surg 2005; 29:794-9. [PMID: 15889218 DOI: 10.1007/s00268-005-7689-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim of this prospective study was to compare the efficacy of oral versus parenteral prophylactic amoxicillin-clavulanic acid for preventing surgical site infection after open prosthetic mesh repair of inguinal hernia. A total of 480 inguinal-hernia patients were randomly assigned to two groups. Group I (n = 240) received 1.313 g oral amoxicillin-clavulanic acid 2 hours before operation, and group II (n = 240) received 1.2 g of the same drug combination intravenously approximately 30 minutes before surgery. Patients were examined four times during 1 year of follow-up (at 7-10 days, 4-6 weeks, 6 months, and 12 months postoperation), and data related to surgical site infections were collected. Seventy-two patients were excluded due to confounding factors during and after the operation. There were no statistically significant differences between group I (final n = 208) and group II (final n = 200) with respect to age, sex distribution, body mass index, American Anesthesiology Association grade, frequencies of different hernia types, duration of surgery, and the experience levels of the principal surgeon in the operations. One of the 208 (0.5%) patients in group I and 3 of the 200 (1.5%) patients in group II developed superficial surgical site infections (p > 0.05). None of the infections required mesh removal. There were no deep surgical site infections in either group, and there was one case of hernia recurrence in each group. For patients undergoing open prosthetic repair of inguinal hernia, oral amoxicillin-clavulanic acid is safe, significantly less costly, and equally effective in preventing surgical site infection as the same dose given parenterally.
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Affiliation(s)
- Mehmet A Kuzu
- Department of Surgery, Ankara University School of Medicine, 06100 Sýhhýye, Ankara, Turkery.
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Berger AP, Gozzi C, Steiner H, Frauscher F, Varkarakis J, Rogatsch H, Bartsch G, Horninger W. COMPLICATION RATE OF TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY: A COMPARISON AMONG 3 PROTOCOLS WITH 6, 10 AND 15 CORES. J Urol 2004; 171:1478-80; discussion 1480-1. [PMID: 15017202 DOI: 10.1097/01.ju.0000116449.01186.f7] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We assessed the complication rate of ultrasound guided prostate biopsies performed at a single center in a screening population. Moreover the impact of different biopsy protocols comprising varying numbers of biopsy cores on the complication rate was evaluated. MATERIALS AND METHODS A total of 5957 biopsies performed in 4303 clinically healthy men between January 1993 and August 2002 was evaluated retrospectively. Due to changes in the biopsy protocol, the number of biopsies obtained increased with time from 6 cores (January 1993 to October 1995) to 10 (November 1995 to March 2000) to 15 cores (March 2000 to August 2002). RESULTS Minor complications such as hematospermia (36.3%), hematuria (14.5%) and rectal bleeding persisting for up to 2 days (2.3%) were noted frequently, while major complications requiring further treatment were far less common. Post-biopsy fever was seen in 48 patients (0.8%), rectal bleeding requiring surgical intervention or persisting for more than 2 days occurred in 36 patients (0.6%) and urinary retention was observed in 12 patients (0.2%). The increase in biopsy cores with time did not result in increased post-biopsy morbidity. Prostate cancer at biopsy was not associated with a higher complication rate. CONCLUSIONS Prostate specific antigen screening has led to an increase in the number of patients undergoing prostate biopsy which, in turn, has increased the incidence of post-biopsy complications. However, most of the complications are minor and self-limiting. In this large study population the increased number of biopsy cores did not result in an increased incidence of major post-biopsy complications.
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Affiliation(s)
- Andreas P Berger
- Department of Urology and Pathology, University of Innsbruck, Innsbruck, Austria.
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Tobias-Machado M, Corrêa TD, De Barros EL, Wroclawski ER. Antibiotic prophylaxis in prostate biopsy: a comparative randomized clinical assay between ciprofloxacin, norfloxacin and chloramphenicol. Int Braz J Urol 2003; 29:313-9. [PMID: 15745554 DOI: 10.1590/s1677-55382003000400005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2002] [Accepted: 07/28/2003] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare, prospectively, 4 different schemes of antibiotic prophylaxis previously to transrectal prostate biopsy. MATERIALS AND METHODS 257 patients were randomized in 4 groups: Group I: single dose of ciprofloxacin 2 hours before the procedure; Group II: ciprofloxacin 3 days; Group III: chloramphenicol 3 days; and Group IV: norfloxacin 3 days. The complication rate was assessed in a blind way on the third and on the thirtieth days through a questionnaire. Groups were compared by the qui-square method and, in small samples, by the Fisher method, with statistical significance of 95%. RESULTS Complications index throughout the sample differed between the 4 groups of patients under study, being 3.1% for group I, 2.1%for group II, 18.3% for group III and 10.5% for group IV. Schemes employing ciprofloxacin were statistically superior to those that used norfloxacin or chloramphenicol (p < 0.05). There was no difference between a single dose and 3 days of ciprofloxacin (p > 0.05). CONCLUSION Schemes using ciprofloxacin presented better results in prophylaxis previously to prostate biopsy. We recommend using a single dose of ciprofloxacin due to its posologic ease and low cost, associated with a therapeutic response equivalent to 3-day regimens.
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Affiliation(s)
- M Tobias-Machado
- Section of Urology, ABC Medical School and Padre Anchieta Teaching Hospital, Santo André, São Paulo, Brazil.
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Tal R, Livne PM, Lask DM, Baniel J. Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy. J Urol 2003; 169:1762-5. [PMID: 12686828 DOI: 10.1097/01.ju.0000061280.23447.29] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Although urinary tract infection is a recognized complication of transrectal ultrasound guided prostate biopsy, to our knowledge there are no recommendations in the literature for its management. We studied the unique features of this infection and provide management recommendations. MATERIALS AND METHODS A prospective design was used. The study group was composed of patients admitted to the emergency department from 2000 to 2001 with complaints suggestive of urinary tract infection after transrectal ultrasound guided prostate biopsy. The indication for biopsy, prophylactic regimen used and clinical manifestations were documented. Urine and blood cultures were obtained at hospital admission and bacterial susceptibility was examined for all positive cultures. RESULTS All 23 patients enrolled in the study underwent biopsy for acceptable indications and 95.7% had received antibiotic prophylaxis, including 69.5% with fluoroquinolones. Infection was typically accompanied by high fever (mean +/- SD 39.1 +/- 0.6C), chills in 78.3% of cases and leukocytosis in 56.5%. All positive blood cultures and 92.9% of positive urine cultures yielded Escherichia coli. Bacterial isolates showed high resistance to fluoroquinolones and trimethoprim-sulfamethoxazole, and 100% susceptibility to second and third generation cephalosporins, amikacin and carbapenems. CONCLUSIONS The successful management of urinary tract infection complicating transrectal prostate biopsy depends on the recognition of its unique features, the pathogens involved and their antimicrobial susceptibility. The recommended empirical treatment is a second or third generation cephalosporin, amikacin or a carbapenem.
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Affiliation(s)
- Raanan Tal
- Institute of Urology, Rabin Medical Center, Beilinson and Golda-Hasharon Campuses, Petah Tikva, Israel
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Abstract
The primary prophylactic measure against postoperative infection is antiseptic technique in patient preparation, during surgery, and in postoperative patient care. Antimicrobial prophylaxis against postoperative infection is not indicated for procedures with a low infection rate because the expected benefit of antimicrobial treatment is less than the risk of an adverse medication reaction. Antimicrobial prophylaxis has been demonstrated to be of greater benefit than risk in some procedures with higher infection rates; however, because the problem is complex and the data are limited, extra-polating these findings to the practitioner's setting and the individual patient remains a challenge (Table 1). Although antimicrobial prophylaxis for bacterial endocarditis is not effective for most patients, the seriousness of the potential infection has driven the creation of guidelines recommending prophylaxis for at-risk patients undergoing at-risk procedures. Applying these guidelines appropriately could help to reduce unwarranted use of antimicrobials. In the prophylactic use of antimicrobials, as in many medical interventions, the difficulty is balancing the risks of the intervention with the potential benefits. Although we do not have either the randomized, controlled trials or the detailed, patient-specific information to estimate this balance precisely, there are general guidelines to help the clinician choose treatment for most patients.
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Affiliation(s)
- Harrison G Weed
- Division of General Internal Medicine, The Ohio State University College of Medicine, 4510 UHC Cramblett Hall, 456 West 10th Avenue, Columbus, OH 43210, USA.
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Griffith BC, Morey AF, Ali-Khan MM, Canby-Hagino E, Foley JP, Rozanski TA. Single dose levofloxacin prophylaxis for prostate biopsy in patients at low risk. J Urol 2002; 168:1021-3. [PMID: 12187213 DOI: 10.1016/s0022-5347(05)64565-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE We determine if a single 500 mg. oral tablet of levofloxacin represents adequate prophylaxis for patients at low risk who undergo transrectal prostate biopsy. MATERIALS AND METHODS From April 2000 to May 2001 we prospectively evaluated 400 consecutive men who underwent transrectal needle biopsy of the prostate after a single 500 mg. oral dose of levofloxacin. Under an institutional review board approved protocol the drug was issued under a standing order by a clinic nurse 30 to 60 minutes before the procedure. Patients were issued 2 additional daily doses of levofloxacin if they were deemed at increased risk for infectious complications, that is if they had a large prostate more than 75 cc, diabetes mellitus, recent steroid use, severe voiding dysfunction or immune compromise. No patient received a cleansing enema before the procedure. Complications, the number of biopsy cores, prostate size and cancer detection rates were assessed. RESULTS Only 1 of the 377 patients at low risk in whom biopsy was completed experienced a symptomatic urinary tract infection (0.27%). None of the 23 men at high risk who received additional doses of levofloxacin experienced a complication. Thus, the overall infection rate was 1 of 400 cases (0.25%) in this series. A mean of 7 biopsy cores (range 2 to 16) was obtained per patient and mean prostate volume was 49.75 cc (range 12 to 150). Prostate cancer was present in 93 patients (23%). CONCLUSIONS A single 500 mg. dose of levofloxacin before transrectal needle biopsy of the prostate is effective and safe in patients at low risk. The administration of prophylaxis by a clinic nurse under a standing order optimizes patient compliance and physician efficiency. In patients at higher risk for infection additional antibiotic administration appears to provide adequate prophylaxis.
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Affiliation(s)
- Brian C Griffith
- Urology Service, Brooke Army Medical Center, San Antonio, TX, USA
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44
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Single Dose Levofloxacin Prophylaxis for Prostate Biopsy in Patients at Low Risk. J Urol 2002. [DOI: 10.1097/00005392-200209000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Is Periprostatic Local Anesthesia For Transrectal Ultrasound Guided Prostate Biopsy Associated With Increased Infectious Or Hemorrhagic Complications? A Prospective Randomized Trial. J Urol 2002. [DOI: 10.1016/s0022-5347(05)64679-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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46
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Is Periprostatic Local Anesthesia For Transrectal Ultrasound Guided Prostate Biopsy Associated With Increased Infectious Or Hemorrhagic Complications? A Prospective Randomized Trial. J Urol 2002. [DOI: 10.1097/00005392-200208000-00033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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47
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48
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Affiliation(s)
- N R Webb
- Department of Urology, The Canberra Hospital, Garran, ACT, Australia
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49
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Paz A, Bauer H, Potasman I. Multiresistant Pseudomonas aeruginosa associated with contaminated transrectal ultrasound. J Hosp Infect 2001; 49:148-9. [PMID: 11567566 DOI: 10.1053/jhin.2001.1056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
This report reviews recent studies on infectious complications and antibiotic prophylaxis in common urological instrumentation. As a result of variations in the definitions of infectious complications and inconsistencies in study design and risk factor analysis there is presently limited clear-cut evidence for giving definite standards regarding antibiotic prophylaxis for most urological interventions. The consequences are that patients may be exposed to unnecessary hazards and the healthcare system to additional costs. Nonetheless, most authors agree that patients should have sterile urine at urological instrumentation and that any other detected risk factor should be controlled. When antibiotic prophylaxis is considered, it should be timed properly before the intervention, which varies with the type of intervention and the choice of antibiotic, and should last for a limited period of time. In most common urological manipulations, correctly administered oral prophylaxis has been shown to be as effective as intravenous prophylaxis. A series of guidelines aimed at keeping the rates of healthcare-associated infections and the level of bacterial resistance as low as possible should, in combination with the rational use of antibiotics, be one of several marks of quality of a urological centre. To achieve this goal, new well-designed studies considering different regimens, risk factor analysis and economical analysis should be encouraged.
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Affiliation(s)
- M Grabe
- Department of Urology, Malmö University Hospital, University of Lund, Malmö, Sweden.
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