The effectiveness of a short perioperative course with pivampicillin/pivmecillinam in transurethral prostatic resection: bacteriological results

Infections after transrectal ultrasonic guided prostate biopsies - a retrospective study

Background: Transrectal ultrasound guided biopsies (TRUSp) are associated with a risk of serious infections. Recently, there has been a rise in incidence of infections after TRUSp and quinolone-resistant bacteria. The most commonly used prophylaxis is ciprofloxacin (CFLX). Objective: To document the incidence and risk factors of post-TRUSp infections and investigate the microbial resistance patterns for the patients presenting with a serious infection after TRUSp. Materials and methods: Data were collected, including age, comorbidity, previous TRUSp, number of biopsies, previously received antibiotics, time between TRUSp and hospitalization, results of microbiological cultivations, antibiotic prophylaxis, and development of infection for all patients at The University Hospital of Southern Denmark, Esbjerg who underwent TRUSp from November 2014 to November 2016. Results: In total, 590 patients were included and 37 (6.1%) patients were hospitalized with symptoms of infection. Of those 37 patients, 21 (56,8%) patients had positive microbiology (blood and/or urine), 18 (48.6%) patients were infected with E. coli and 11 (29.7%) patients had CFLX-resistant E. coli. If patients had previously received antibiotics, they had a significantly higher risk of developing infection after TRUSp (p = 0.01). Conclusion: Patients who have been exposed to antibiotics before TRUSp are at higher risk of developing serious infections as a complication to TRUSp. CFLX-resistant E. coli were a major reason for hospitalization.

Penetration of a single infusion of ampicillin and sulbactam into prostatic tissue during transurethral prostatectomy

Antibiotic prophylaxis is recommended in endoscopic urological operations to diminish the rate of intraoperative septic complications and relevant urogenital infections. The objective of the study was to determine the tissue concentrations of preoperatively administered ampicillin and sulbactam in the human prostate in patients undergoing transurethral resection (TUR-P) for benign prostatic hyperplasia (BPH). In 19 patients (mean age 68.7 years) the serum and tissue concentrations of ampicillin and sulbactam were determined. For all patients the dosage was administered as a single infusion over 15 min at a 2:1 ratio, i.e. 2 g ampicillin and 1 g sulbactam. The serum and prostatic tissue samples were taken 15 to 55 min (mean 29.5 min) after infusion. Of transurethral resected prostatic chips 3 g were immediately collected after resection and stored at -70 degrees C. Ampicillin was determined by bioassay and sulbactam was determined by gas chromatography/mass spectrometry. Tissue concentrations of ampicillin ranged from 0.42 to 548.33 mg/kg (median 47 mg/kg). Tissue concentrations of sulbactam ranged from 0.15 to 249.74 mg/kg (median 19 mg/kg). Six (32%) of 19 patients showed a tissue concentration of ampicillin <4 mg/kg (MIC90), respectively 5 (26%) patients of sulbactam <8 mg/kg. The mean serum concentrations at tissue sampling time were 118.8+/-48.9 mg/l respectively 32.2+/-12.2 mg/l. There exists a high variability of intraprostatic concentrations of ampicillin and sulbactam after single infusion in patients with BPH. In a relevant part of patients both compounds do not exceed the minimal inhibitory concentrations (MIC) of important bacterial pathogens. A single shot infusion of 3 g ampicillin/sulbactam for intraoperative antibiotic prophylaxis is not sufficient in patients undergoing TUR-P. It seems that the prostate cannot be compared to other tissues in view of penetration of ampicillin/sulbactam.