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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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Hanna MY, Tremlett C, Josan G, Eltom A, Mills R, Rochester M, Livermore DM. Prevalence of ciprofloxacin-resistant Enterobacteriaceae in the intestinal flora of patients undergoing transrectal prostate biopsy in Norwich, UK. BJU Int 2015; 116:131-4. [DOI: 10.1111/bju.12865] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | - Catherine Tremlett
- Department of Microbiology; Norfolk and Norwich University Hospital; Norwich UK
| | - Gurvir Josan
- Department of Urology; Norfolk and Norwich University Hospital; Norwich UK
| | - Ali Eltom
- Department of Urology; Norfolk and Norwich University Hospital; Norwich UK
| | - Robert Mills
- Department of Urology; Norfolk and Norwich University Hospital; Norwich UK
| | - Mark Rochester
- Department of Urology; Norfolk and Norwich University Hospital; Norwich UK
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Reduction in Hospital Admissions With the Addition of Prophylactic Intramuscular Ceftriaxone Before Transrectal Ultrasonography–guided Prostate Biopsies. Urology 2015; 85:511-6. [DOI: 10.1016/j.urology.2014.10.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/16/2014] [Accepted: 10/18/2014] [Indexed: 11/19/2022]
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Sutcliffe J, Briggs J, Little M, McCarthy E, Wigham A, Bratby M, Tapping C, Anthony S, Patel R, Phillips-Hughes J, Boardman P, Uberoi R. Antibiotics in interventional radiology. Clin Radiol 2015; 70:223-34. [DOI: 10.1016/j.crad.2014.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 09/28/2014] [Accepted: 09/30/2014] [Indexed: 12/18/2022]
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Yildirim ME, Badem H, Cavis M, Karatas OF, Cimentepe E, Unal D, Incebay IB. The comparison of the influence between two different bowel preparation methods on sepsis after prostate biopsies. Cent European J Urol 2015; 68:91-4. [PMID: 25914845 PMCID: PMC4408382 DOI: 10.5173/ceju.2015.01.424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 08/26/2014] [Accepted: 10/20/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction Transrectal ultrasonography (TRUS) guided prostate needle biopsy has been performed to diagnose and stage prostate cancer for many years. There are many different bowel preparation protocols to diminish the infectious complications, but there is no standardized consensus among urologists. Therefore, we aimed to assess two different bowel preparation methods on the rate of infectious complications in patients who underwent TRUS–guided prostate biopsy. Material and methods A total of 387 cases of TRUS–guided prostate biopsy were included in this retrospective study. All patients received antibiotic prophylaxis with ciprofloxacin (500 mg) twice a day orally for 7 days starting on the day before the biopsy. The patients were divided into two groups according to the bowel preparation method used. Patients (Group 1, n = 164) only received self–administrated phosphate enema) on the morning of the prostate biopsy. Other patients (Group 2, n = 223) received sennasoid a–b laxatives the night before the prostate biopsy. Infectious complications were classified as sepsis, fever (greater than 38°C) without sepsis, and other clinical infections. Results Major complications developed in 14 cases (3.8%), including 3 cases (0.8%) of urinary retention, and 11 (3%) infectious complications, all of which were sepsis. There were 3 and 8 cases of urosepsis in Group 1 and Group 2, respectively. There were no statistically significant differences between both Groups regarding to the rates of urosepsis (p = 0.358). Conclusions Despite both methods of bowel preparation, sodium phosphate enema or sennasoid a–b calcium laxatives, before TRUS–guided prostate biopsy have similar effect on the rate of urosepsis, so both methods of bowel preparation can be safely used.
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Affiliation(s)
| | - Huseyin Badem
- Yüksek İhtisas Training and Research Hospital Department of Urology, Ankara, Turkey
| | - Mucahit Cavis
- Turgut Ozal University School of Medicine Department of Urology, Ankara, Turkey
| | - Omer Faruk Karatas
- Turgut Ozal University School of Medicine Department of Urology, Ankara, Turkey
| | - Ersin Cimentepe
- Turgut Ozal University School of Medicine Department of Urology, Ankara, Turkey
| | - Dogan Unal
- Hacettepe University School of Medicine Department of Urology, Ankara, Turkey
| | - Ilkay Bekir Incebay
- Turgut Ozal University School of Medicine Department of Urology, Ankara, Turkey
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Otrock ZK, Oghlakian GO, Salamoun MM, Haddad M, Bizri ARN. Incidence of Urinary Tract Infection Following Transrectal Ultrasound Guided Prostate Biopsy at a Tertiary-Care Medical Center in Lebanon. Infect Control Hosp Epidemiol 2015; 25:873-7. [PMID: 15518032 DOI: 10.1086/502312] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractObjective:To determine the incidence of urinary tract infections (UTIs) following transrectal ultrasound guided needle biopsy of the prostate (TRUBP) and the bacteriology of these infections.Design:Retrospective evaluation of the charts and records of all patients who underwent TRUBP between June 1, 2002, and August 31, 2003.Setting:American University of Beirut Medical Center, a tertiary-care center in Lebanon.Patients:Two hundred seven patients underwent TRUBP. All received prophylactic antibiotics. One hundred twenty (58%) received ciprofloxacin alone, whereas 87 (42%) received both ciprofloxacin and gentamicin. Sixty-one patients (29.5%) had an enema prior to the procedure, whereas 146 (70.5%) did not.Results:Thirteen patients (6.3%) were admitted with UTI. All had rigors and fever on admission. Symptoms appeared at a mean of 2.7 days and the mean hospital stay was 9.2 days. The mean duration of antibiotic treatment was 23.2 days. Ten (77%) of the patients had positive bacteriology. Urine cultures were positive in 8 (61.5%) of the patients and blood cultures in 6 (46.2%). All positive cultures grew Escherichia coli resistant to ciprofloxacin, with 5 isolates producing extended-spectrum beta-lactamases.Conclusions:TRUBP continues to be associated with significant infectious complications, especially UTI. Given the increasing incidence of antibiotic resistance mainly among the Enterobacteriaceae, antimicrobial prophylaxis practices should be reevaluated and the universal administration of quinolones alone or in combination with aminoglycosides should be reconsidered.
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Affiliation(s)
- Zaher K Otrock
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Tsu JHL, Ma WK, Chan WKW, Lam BHS, To KC, To WK, Ng TK, Liu PL, Cheung FK, Yiu MK. Prevalence and Predictive Factors of Harboring Fluoroquinolone-resistant and Extended-spectrum β-Lactamase–producing Rectal Flora in Hong Kong Chinese Men Undergoing Transrectal Ultrasound-guided Prostate Biopsy. Urology 2015; 85:15-21. [DOI: 10.1016/j.urology.2014.07.078] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/28/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
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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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60
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Bacteriology profile of febrile infectious complications after transrectal ultrasound-guided prostate biopsy. UROLOGICAL SCIENCE 2014. [DOI: 10.1016/j.urols.2014.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Antsupova V, Norgaard N, Bisbjerg R, Nygaard Jensen J, Boel J, Jarlov JO, Arpi M. Antibiotic prophylaxis for transrectal prostate biopsy--a new strategy. J Antimicrob Chemother 2014; 69:3372-8. [DOI: 10.1093/jac/dku293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Park DS, Hwang JH, Choi DK, Gong IH, Hong YK, Park S, Oh JJ. Control of Infective Complications of Transrectal Prostate Biopsy. Surg Infect (Larchmt) 2014; 15:431-6. [DOI: 10.1089/sur.2013.138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dong Soo Park
- Department of Urology, CHA Bundang Medical Center, CHA University, Sungnam, Korea
| | - Jin Ho Hwang
- Department of Urology, CHA Bundang Medical Center, CHA University, Sungnam, Korea
| | - Don Kyung Choi
- Department of Urology, CHA Bundang Medical Center, CHA University, Sungnam, Korea
| | - In Hyuck Gong
- Department of Urology, CHA Bundang Medical Center, CHA University, Sungnam, Korea
| | - Young Kwon Hong
- Department of Urology, CHA Bundang Medical Center, CHA University, Sungnam, Korea
| | - Sujin Park
- CHA Cancer Research institute, Seoul, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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Yasuda M, Nakane K, Yamada Y, Matsumoto M, Sho T, Matsumoto M, Kobayashi K, Shigemura K, Nakano Y, Tanaka K, Hamasuna R, Ishihara S, Arakawa S, Yamamoto S, Matsubara A, Fujisawa M, Deguchi T, Matsumoto T. Clinical effectiveness and safety of tazobactam/piperacillin 4.5 g for the prevention of febrile infectious complication after prostate biopsy. J Infect Chemother 2014; 20:631-4. [PMID: 25043444 DOI: 10.1016/j.jiac.2014.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 06/10/2014] [Accepted: 06/24/2014] [Indexed: 11/26/2022]
Abstract
We investigated the clinical effectiveness and safety of tazobactam/piperacillin (TAZ/PIPC) in a 1:8 ratio, a β-lactamase inhibitor with penicillin antibiotic, for the prevention of febrile infectious complication after prostate biopsy. Each patient received a single dose of TAZ/PIPC 4.5 g, 30 min before the biopsy in Group 1 or TAZ/PIPC 4.5 g twice, once 30 min before and once after the biopsy (just before discharge or 5 h after the biopsy), in Group 2. Estimation of efficacy was performed within 1-month after prostate biopsy. Clinical diagnosis of febrile infectious complication was based on a body temperature elevation greater than 38 °C. Infectious complication after prostate biopsy was detected in 2.5% (4/160 patients) in Group 1 and in 0.45% (2/442 patients) in Group 2. All of the patients with febrile infectious complication had risk factors: 5 patients had voiding disturbance, 2 patients had diabetes mellitus and 1 patient had steroid dosing. In group 1, 88 patients had at least one risk factor and 72 patients had no risk factors. Of the patients with a risk factor, 4 had febrile infectious complication after prostate biopsy, but there was no significant difference between the two groups. In group 2, 87 patients had at least one risk factor and 255 patients had no risk factors. The patients with a risk factor had febrile infectious complication significantly more frequently than did patients without a risk factor (P = 0.038). Therefore, TAZ/PIPC appears to be effective as preoperative prophylaxis against the occurrence of febrile infectious complication after prostate biopsy.
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Affiliation(s)
- Mitsuru Yasuda
- Department of Urology, Gifu University Hospital, Japan; Japanese Research Group for Urinary Tract Infection, Japan.
| | - Keita Nakane
- Department of Urology, Gifu University Hospital, Japan
| | | | - Masahiro Matsumoto
- Department of Urology, University of Occupational and Environmental Health, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Takehiko Sho
- Department of Urology, University of Occupational and Environmental Health, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Minori Matsumoto
- Division of Urology, Kobe University Graduate School of Medicine, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Kanao Kobayashi
- Department of Urology, Chugoku Rosai Hospital, Japan Labour Health and Welfare Organization, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Katsumi Shigemura
- Department of Urology, Shinko Hospital, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Yuzo Nakano
- Division of Urology, Kobe University Graduate School of Medicine, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Kazushi Tanaka
- Division of Urology, Kobe University Graduate School of Medicine, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Ryoichi Hamasuna
- Department of Urology, University of Occupational and Environmental Health, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Satoshi Ishihara
- Department of Urology, Kizawa Memorial Hospital, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Soichi Arakawa
- Division of Urology, Kobe University Graduate School of Medicine, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Akio Matsubara
- Department of Urology, Hiroshima University Institute of Biomedical and Health Sciences, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Takashi Deguchi
- Department of Urology, Gifu University Hospital, Japan; Japanese Research Group for Urinary Tract Infection, Japan
| | - Tetsuro Matsumoto
- Department of Urology, University of Occupational and Environmental Health, Japan; Japanese Research Group for Urinary Tract Infection, Japan
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64
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Togo Y, Kubo T, Taoka R, Hiyama Y, Uehara T, Hashimoto J, Kurimura Y, Takahashi S, Tsukamoto T, Miyazaki J, Nishiyama H, Kira S, Kiyota H, Yazawa S, Niwa N, Hongo H, Oya M, Kato T, Yasuda M, Deguchi T, Ishikawa K, Hoshinaga K, Matsumoto M, Shigemura K, Tanaka K, Arakawa S, Fujisawa M, Wada K, Uehara S, Watanabe T, Kumon H, Kobayashi K, Matsubara A, Matsumoto M, Sho T, Hamasuna R, Matsumoto T, Hayami H, Nakagawa M, Yamamoto S. Occurrence of infection following prostate biopsy procedures in Japan. J Infect Chemother 2014; 20:232-7. [DOI: 10.1016/j.jiac.2013.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 11/28/2022]
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Kim JB, Jung SI, Hwang EC, Kwon DD. Prevalence of antibiotic-resistant bacteria on rectal swabs and factors affecting resistance to antibiotics in patients undergoing prostate biopsy. Korean J Urol 2014; 55:201-6. [PMID: 24648876 PMCID: PMC3956950 DOI: 10.4111/kju.2014.55.3.201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/01/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose The prevalence of antibiotic-resistant bacteria on rectal swabs in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy and the factors affecting resistance to antibiotics were evaluated. Materials and Methods Two hundred twenty-three men who underwent TRUS-guided prostate biopsy from November 2011 to December 2012 were retrospectively evaluated. Rectal swabs were cultured on MacConkey agar to identify antibiotic-resistant bacteria in rectal flora before TRUS-guided prostate biopsy. All patients were admitted and received intravenous antibiotics before prostate biopsy. Clinical variables including underlying disease, infectious complications, and antibiotics associated with resistance were evaluated. Logistic regression was used to determine the factors influencing antibiotic resistance. Results Of the 233 patients, 161 had positive rectal cultures. Escherichia coli was cultured in 130 (80.7%) and Klebsiella pneumonia in 16 (9.9%). The prevalence of quinolone resistance was 16.8% and the prevalence of extended-spectrum beta-lactamase (ESBL) positivity was 9.3%. A previous history of prostatitis was correlated with quinolone resistance and ESBL positivity (both p=0.001). The factors affecting quinolone resistance in the univariate analysis were a previous history of prostatitis (p=0.003) and previous exposure to antibiotics (p=0.040). Only a previous history of prostatitis was statistically significant in the multivariate analysis (p=0.014). Four patients had infectious complications. Conclusions The prevalence of quinolone resistance was 16.8% in rectal swabs performed before TRUS-guided prostate biopsy. A previous history of prostatitis was influential. In patients with a history of prostatitis, selection of prophylactic antibiotics before the biopsy may be reconsidered.
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Affiliation(s)
- Jong Beom Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Losco G, Studd R, Blackmore T. Ertapenem prophylaxis reduces sepsis after transrectal biopsy of the prostate. BJU Int 2014; 113 Suppl 2:69-72. [DOI: 10.1111/bju.12590] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Giovanni Losco
- Department of Urology; Wellington Regional Hospital; Wellington New Zealand
| | - Rod Studd
- Department of Urology; Wellington Regional Hospital; Wellington New Zealand
| | - Timothy Blackmore
- Department of Infectious Diseases and Microbiology; Wellington Regional Hospital; Wellington New Zealand
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Single Dose of Levofloxacin versus Three Dosages for Prophylaxis in Prostate Biopsy. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:875670. [PMID: 27437497 PMCID: PMC4897165 DOI: 10.1155/2014/875670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/23/2014] [Indexed: 11/17/2022]
Abstract
Transrectal ultrasound-guided core prostate biopsy is a key event in the diagnosis of prostate cancer, transient side events such as local pain, haematuria, haematospermia, dysuria, and rectal bleeding are reported in a large number of patients. Antimicrobial agents lower the incidence of postbiopsy infectious complications. The timing and duration of the regimen and the route of administration remain controversial. We developed a standard prophylactic regimen, in which safety and efficiency were maximized, while costs and variability were minimized. Accordingly we prospectively evaluated 425 consecutive patients, who underwent outpatient transrectal ultrasound-guided prostate biopsy after a single dose versus three doses of levofloxacin.
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Abstract
Transperineal prostate biopsy is re-emerging after decades of being an underused alternative to transrectal biopsy guided by transrectal ultrasonography (TRUS). Factors driving this change include possible improved cancer detection rates, improved sampling of the anteroapical regions of the prostate, a reduced risk of false negative results and a reduced risk of underestimating disease volume and grade. The increasing incidence of antimicrobial resistance and patients with diabetes mellitus who are at high risk of sepsis also favours transperineal biopsy as a sterile alternative to standard TRUS-guided biopsy. Factors limiting its use include increased time, training and financial constraints as well as the need for high-grade anaesthesia. Furthermore, the necessary equipment for transperineal biopsy is not widely available. However, the expansion of transperineal biopsy has been propagated by the increase in multiparametric MRI-guided biopsies, which often use the transperineal approach. Used with MRI imaging, transperineal biopsy has led to improvements in cancer detection rates, more-accurate grading of cancer severity and reduced risk of diagnosing clinically insignificant disease. Targeted biopsy under MRI guidance can reduce the number of cores required, reducing the risk of complications from needle biopsy.
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69
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Abstract
Grayscale transrectal ultrasonographic prostate biopsy using local anesthesia remains the standard approach to the definitive diagnosis of prostate cancer. Careful patient evaluation and preparation are essential to maximize the results and minimize the complications of the biopsy procedure.
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Affiliation(s)
- Mohamed T Ismail
- Department of Urology, VA Medical Center, 1601 Kirkwood Highway, Wilmington, DE 19805, USA; Department of Urology, Thomas Jefferson University, 1025 Walnut Street, 1102, Philadelphia, PA 19107, USA
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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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Schaeffer AJ. Ciprofloxacin resistance in the faecal carriage of patients undergoing transrectal ultrasound-guided prostate biopsy. BJU Int 2013; 111:853-4. [PMID: 23615027 DOI: 10.1111/bju.12155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jeremiah CJ, Spelman DW, Royce PL, Cheng AC. Gentamicin and norfloxacin prophylaxis for transrectal ultrasound-guided prostate biopsy. ACTA ACUST UNITED AC 2013. [DOI: 10.1071/hi12043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Qi C, Malczynski M, Schaeffer AJ, Barajas G, Nadler RB, Scheetz MH, Zembower TR. Characterization of ciprofloxacin resistant Escherichia coli isolates among men undergoing evaluation for transrectal ultrasound guided prostate biopsy. J Urol 2013; 190:2026-32. [PMID: 23727416 DOI: 10.1016/j.juro.2013.05.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We determine the prevalence of ciprofloxacin resistant gram-negative bacilli in patients scheduled for transrectal ultrasound guided prostate biopsy, characterize the Escherichia coli strains recovered from this patient population, and characterize the mechanisms responsible for β-lactam and ciprofloxacin resistance. MATERIALS AND METHODS Rectal swabs from 991 patients were cultured for ciprofloxacin resistant gram-negative bacilli with a selective medium. Recovered E. coli isolates were further analyzed with susceptibility testing, pulsed field gel electrophoresis, plasmid isolation and sequencing. RESULTS A total of 193 ciprofloxacin resistant gram-negative bacilli were recovered and of these isolates 167 (87%) were E. coli. The prevalence of ciprofloxacin resistant E. coli in the study population was 17%. Only 38 (26%) of the 149 E. coli isolates that received susceptibility testing were susceptible to ampicillin and ampicillin-sulbactam. In select isolates transferrable plasmids carrying β-lactamase were responsible for the resistance to the β-lactam agents and other nonβ-lactam antimicrobials. Diverse combinations of gyrA and parC mutations associated with fluoroquinolone resistance were identified. Strain typing and plasmid typing indicated that the E. coli isolates did not share a common origin. CONCLUSIONS Of the patients in our study 17% carried ciprofloxacin resistant E. coli. Analysis of resistance mechanisms and plasmid analysis along with strain typing demonstrated that this patient population harbored organisms with heterogeneous phenotypic susceptibility, indicating that universal prophylaxis would not provide optimal coverage for patients undergoing transrectal ultrasound guided prostate biopsy.
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Affiliation(s)
- Chao Qi
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Clinical Microbiology Laboratory, Northwestern Memorial Hospital, Chicago, Illinois.
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Oh MM, Chae JY, Kim JW, Kim JW, Yoon CY, Park MG, Moon DG. Positive culture for extended-spectrum β-lactamase during acute prostatitis after prostate biopsy is a risk factor for progression to chronic prostatitis. Urology 2013; 81:1209-12. [PMID: 23601450 DOI: 10.1016/j.urology.2013.02.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 02/19/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze whether strains positive for extended-spectrum β-lactamase (ESBL) affected the clinical course and progression to chronic prostatitis in patients with postbiopsy acute prostatitis. METHODS From 2002 to 2011, 3657 patients underwent transrectal ultrasound-guided biopsy of the prostate, and 33 patients with acute prostatitis were enrolled. Acute prostatitis was defined as a fever greater than 38°C, pyuria, and tenderness on digital rectal examination. Urine and blood cultures were tested for antibiotic susceptibility. Laboratory and clinical variables according to the presence of ESBL were analyzed. RESULTS Blood or urine culture was positive in 23 patients. The most common strain was Escherichia coli. Sixteen patients showed ESBL-positive and 18 patients were quinolone-resistant. Thirteen of 16 patients with ESBL-positive strains showed quinolone resistance, and 13 of 18 patients with quinolone resistance were ESBL-positive (P = .621). Besides imipenem, all ESBL-positive patients were susceptible to amikacin and were highly susceptible to cefoxitin and amoxicillin/clavulanic acid. The prevalence of ESBL-positive strains has tended to increase since 2006. Patients with ESBL had higher peak fever, white blood cell count, absolute neutrophil count, and longer duration of fever and hospitalization. The progression rate to chronic prostatitis was significantly higher in ESBL-positive patients (4/16 vs 0/17, P = .044). CONCLUSION Since 2006, ESBL strains have been increasing, and the presence of ESBL showed more detrimental effects on the clinical course of the patients, resulting in a higher rate of progression to chronic prostatitis.
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Affiliation(s)
- Mi Mi Oh
- Department of Urology, Korea University Medical Center, Seoul, Korea
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Solha RS, Ajzen S, De Nicola H, Shigueoka DC, Castro HASD. Morbidade da biópsia da próstata transretal guiada por ultrassonografia. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a incidência de complicações pós-procedimento nos pacientes submetidos a biópsia prostática transretal guiada por ultrassom no setor de intervenção do Departamento de Diagnóstico por Imagem da Escola Paulista de Medicina - Universidade Federal de São Paulo. MATERIAIS E MÉTODOS: Foram avaliados, via contato telefônico, 132 pacientes submetidos a biópsia de próstata transretal guiada por ultrassom no período de abril/2011 a junho/2011, seguindo o protocolo padrão do nosso setor. RESULTADOS: As complicações pós-biópsia foram categorizadas em maiores e menores de acordo com a necessidade de avaliação médica adicional. Cinquenta e nove pacientes (61,8%) apresentaram complicações, e desses, grande parte (86,4%) apresentou sintomas leves e autolimitados, considerados menores. Oito pacientes (8,2%) apresentaram complicações maiores, sendo que apenas um deles necessitou de tratamento sob regime de internação hospitalar. A retenção urinária foi a complicação maior mais incidente no nosso estudo. CONCLUSÃO: Corroborando outros estudos da literatura, nosso trabalho demonstrou baixa prevalência de complicações maiores após a biópsia prostática transretal.
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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: 698] [Impact Index Per Article: 63.5] [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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Kehinde EO, Al-Maghrebi M, Sheikh M, Anim JT. Combined Ciprofloxacin and Amikacin Prophylaxis in the Prevention of Septicemia After Transrectal Ultrasound Guided Biopsy of the Prostate. J Urol 2013; 189:911-5. [DOI: 10.1016/j.juro.2012.08.237] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 08/28/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Elijah O. Kehinde
- Department of Surgery (Division of Urology), Faculty of Medicine, Kuwait University, Kuwait
| | - May Al-Maghrebi
- Department of Biochemistry, Faculty of Medicine, Kuwait University, Kuwait
| | - Mehraj Sheikh
- Department of Radiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Jehoram T. Anim
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
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Bang JH, Choe HS, Lee DS, Lee SJ, Cho YH. Microbiological characteristics of acute prostatitis after transrectal prostate biopsy. Korean J Urol 2013; 54:117-22. [PMID: 23550205 PMCID: PMC3580301 DOI: 10.4111/kju.2013.54.2.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/12/2012] [Indexed: 12/05/2022] Open
Abstract
Purpose We aimed to identify microbiological characteristics in patients with acute prostatitis after transrectal prostate biopsy to provide guidance in the review of prevention and treatment protocols. Materials and Methods A retrospective analysis of medical records was performed in 1,814 cases who underwent prostate biopsy at Seoul St. Mary's Hospital and St. Vincent's Hospital over a 5 year period from 2006 to 2011. Cases in which acute prostatitis occurred within 7 days after the biopsy were investigated. Before starting treatment with antibiotics, sample collections were done for culture of urine and blood. Culture and drug susceptibility was identified by use of a method established by the Clinical and Laboratory Standards Institute. Results A total of 1,814 biopsy procedures were performed in 1,541 patients. For 1,246 patients, the procedure was the first biopsy, whereas for 295 patients it was a repeat biopsy. Twenty-one patients (1.36%) were identified as having acute bacterial prostatitis after the biopsy. Fifteen patients (1.2%) had acute prostatitis after the first biopsy, and 6 patients (2.03%) experienced acute prostatitis after a repeat biopsy. Even though the incidence of acute bacterial prostatitis was higher after repeat biopsy than that after the first biopsy, there was no statistically significant intergroup difference in terms of incidence (χ2=1.223, p=0.269). When the collected urine and blood samples were cultured, Escherichia coli was found in samples from 15 patients (71.4%), Klebsiella pneumoniae in 3 patients (14.3%), Enterobacter intermedius in 1 patient (4.8%), E. aerogenes in 1 patient (4.8%), and Pseudomonas aeruginosa in 1 patient (4.8%). A fluoroquinolone-resistant strain was confirmed in 5 cases (23.8%) in total. Three cases of E. coli and 1 case of Klebsiella had extended-spectrum β-lactamase activity. Conclusions Empirical treatment of acute prostatitis should be done with consideration of geographical prevalence and drug resistance. This study will provide meaningful information for the management of acute prostatitis after transrectal prostate biopsy.
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Affiliation(s)
- Jun-Ho Bang
- Department of Urology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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79
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Adibi M, Hornberger B, Bhat D, Raj G, Roehrborn CG, Lotan Y. Reduction in Hospital Admission Rates Due to Post-Prostate Biopsy Infections After Augmenting Standard Antibiotic Prophylaxis. J Urol 2013; 189:535-40. [DOI: 10.1016/j.juro.2012.08.194] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Mehrad Adibi
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brad Hornberger
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deepa Bhat
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ganesh Raj
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, Texas
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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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Increasing Hospital Admission Rates for Urological Complications After Transrectal Ultrasound Guided Prostate Biopsy. J Urol 2013; 189:S12-7; discussion S17-8. [DOI: 10.1016/j.juro.2012.11.015] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Indexed: 11/21/2022]
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Rumaihi KA, Majzoub AA, Younes N, Shokeir A. Does intravenous cefuroxime improve the efficacy of ciprofloxacin for preventing infectious complications after transrectal prostate biopsy? A prospective comparative study. Arab J Urol 2012; 10:388-93. [PMID: 26558055 PMCID: PMC4442934 DOI: 10.1016/j.aju.2012.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives To compare the frequency of infection after transrectal ultrasonography (TRUS)-guided biopsy of the prostate (TRUSBP) using prophylactic ciprofloxacin with or without adding cefuroxime. Patients and methods Between June 2008 and October 2009, 205 consecutive patients had TRUSBP with the use of oral 500 mg ciprofloxacin twice per day, 2 days before and 3 days after the biopsy (defined as group A). Starting from November 2009 and onwards, 250 consecutive patients had TRUSBP using the same previous protocol of antibiotic prophylaxis but with the addition of intravenous 1.5 g cefuroxime given 30 min before the procedure (defined as group B). The incidence of sepsis after TRUSBP, together with the results of urine and blood cultures and antibiotic sensitivity, were compared between the groups. Results Fever after TRUSBP was recorded in 18 of 205 patients in group A (8.8%) and in nine of 250 in group B (3.6%); the difference was significant (P = 0.018). Urine culture was positive in 14 and five of patients in groups A and B, respectively, with extended-spectrum β-lactamase-producing (ESBL) Escherichia coli as the most common organism. The blood culture was positive in seven and three patients in groups A and B, respectively, with ESBL E. coli as the most common organism. All patients who had sepsis after TRUSBP sepsis were treated successfully. Conclusion Adding a single intravenous injection with 1.5 g of cefuroxime to oral ciprofloxacin significantly reduced the frequency of infectious complications after TRUSBP.
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Affiliation(s)
| | - Ahmad A Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Nagy Younes
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Shokeir
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
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Batura D, Gopal Rao G. The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention. J Antimicrob Chemother 2012; 68:247-9. [DOI: 10.1093/jac/dks401] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Ongün S, Aslan G, Avkan-Oguz V. The effectiveness of single-dose fosfomycin as antimicrobial prophylaxis for patients undergoing transrectal ultrasound-guided biopsy of the prostate. Urol Int 2012; 89:439-44. [PMID: 23006631 DOI: 10.1159/000342370] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/27/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES It was the aim of this study to evaluate the efficacy of single-dose fosfomycin prophylaxis as an alternative to fluoroquinolone-based prophylaxis in transrectal ultrasound-guided biopsy of the prostate (TRUSBP). METHODS We evaluated the records of 620 patients who had undergone TRUSBP from January 2010 to July 2011. Patients received a single dose of 3 g oral fosfomycin or a single dose of 500 mg oral levofloxacin or 500 mg oral ciprofloxacin twice daily administered for 5 days starting 1 day before the prophylaxis procedure. We reviewed all febrile and afebrile urinary tract infections (UTIs) within 1 month after TRUSBP. RESULTS Of the 620 patients, 19 (3.0%) developed febrile UTI and 51 (8.2%) developed afebrile UTI after biopsy. Of the 19 patients with febrile UTI, 1/19 (5.2%) received fosfomycin, 4/19 (21%) received levofloxacin and 14/19 (73.6%) received ciprofloxacin for prophylaxis. Of the 51 patients with afebrile UTI, 4/51 (7.8%) received fosfomycin, 8/51 (15.6%) received levofloxacin and 39/51 (76.4%) received ciprofloxacin for prophylaxis. There were a total of 10 fluoroquinolone-resistant infections, and all of them occurred after the ciprofloxacin or levofloxacin prophylaxis and none after fosfomycin prophylaxis. CONCLUSIONS The ease of use of fosfomycin, reducing the rate of fluoroquinolone-resistant infections and hospitalizations shows that it would be an alternative and effective drug for antimicrobial prophylaxis in TRUSBP.
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Affiliation(s)
- Sakir Ongün
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey. sakirongun @ hotmail.com
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Mohamed ZK, Dominguez-Escrig J, Vasdev N, Bharathan B, Greene D. The prognostic value of transrectal ultrasound guided biopsy in patients over 70 years old with a prostate specific Antigen (PSA) level ≤ 15 ng/ml and normal digital rectal examination: a 10-year prospective follow-up study of 427 consecutive patients. Urol Oncol 2012; 31:1489-96. [PMID: 22591749 DOI: 10.1016/j.urolonc.2012.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/24/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION As a urologist, it is common to review a patient above the age of 70 being referred to a prostate assessments clinic with an elevated PSA. We evaluate the prognosis of these patients clinically as there is no international consensus on the exact PSA cutoff level or a single international guideline as to when these patients should be offered a prostate biopsy. PATIENTS AND METHODS On receiving ethic committee approval, we recruited 427 consecutive patients aged 70 years and above referred with a PSA of ≥ 4 ng/ml, from January 1996 to December 2000, into our study. All patients were assessed, examined with a digital rectal examination (DRE) of the prostate, and a subsequent prostate biopsy. We followed up on their histologic diagnosis for up to 10 years and analyzed their outcome. The main outcome measures were disease-free survival and overall survival, stratified according to the PSA level (≤ 15 vs. >15 ng/ml) and DRE findings (normal vs. sbnormal). RESULTS There was a statistically significant difference in the overall survival (P value < 0.011) and disease specific survival (P value < 0.0001) of cancer patients with a PSA was >15 ng/ml and an abnormal DRE. However, in patients with a PSA ≤ 15 ng/ml and normal DRE, the incidence of cancer was low and they had no disease-specific or overall survival benefit. CONCLUSIONS A policy of deferring prostate biopsy in patients with a PSA ≤ 15 ng/ml and normal DRE (Group A) would significantly decrease the need of unnecessary prostate biopsies. Within this group, patients did not have any survival advantage compared with those without cancer. We conclude that up to 20% of the prostate biopsies performed in this age group could have been avoided.
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McCormack M, Duclos A, Latour M, McCormack MH, Liberman D, Djahangirian O, Bergeron J, Valiquette L, Zorn K. Effect of needle size on cancer detection, pain, bleeding and infection in TRUS-guided prostate biopsies: A prospective trial. Can Urol Assoc J 2012; 6:97-101. [PMID: 22511415 PMCID: PMC3328562 DOI: 10.5489/cuaj.11169] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Transrectal ultrasound (TRUS)-guided prostate biopsies using 18G calibre needles are widely used; most often 12-core tissue samples of the peripheral zone are obtained. Although the diagnostic yield of prostate biopsies is fair, there is still a potential for false negative results, which necessitates repeat biopsies. In an effort to improve the accuracy of prostate biopsies, different sampling schemes have been developed. One strategy has been to increase the number of core biopsies performed on each patient. Another strategy has been to improve the reliability of prostate biopsies using larger calibre needles, thereby increasing the amount of tissue obtained for each core biopsy. METHODS After approval by our institutional review board, we prospectively compared two biopsy needle sizes (18G vs. 16G) in relation to prostate cancer diagnosis, pain, bleeding and infection rates on 105 patients. Each patient underwent 6 TRUS-guided prostate biopsies with the standard 18G needle and 6 other biopsies with the experimental 16G needle. To evaluate possible complications related to the use of a larger 16G needle in the experimental group, we compared pain, bleeding and infection rates with a control group of 100 patients who underwent 12 biopsies with a single 18G needle (18G group). Pain, bleeding assessment and infection events were evaluated using patient questionnaires and telephone interviews. RESULTS TRUS-guided prostate biopsies using 16G calibre needles did not increase cancer detection or non-malignant pathology rate, including prostatic intraepithelial neoplasia (PIN) and atypical small acinar proliferatio (ASAP). Pain, bleeding and infectious complications were similar in both groups. Infection was defined as temperature above 38°C occurring within 48 hours after the procedure. We identified 4 patients with post-biopsy fever in the experimental (16/18G) group and 4 other patients in the (18G) control group. The post-biopsy infection rate is higher than reported just a few years ago and indicates that quinolone resistant Escherichia coli seems to be more prevalent in our urban setting than previously suspected. Limitations to our study include small group numbers. CONCLUSION Larger 16G needles appear to be safe for TRUS-guided prostate biopsies. Further study in a larger, multi-institutional, prospective, randomized manner with 16G needles is warranted to assess the theoretical benefit of larger core biopsies in prostate cancer detection.
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Affiliation(s)
- Michael McCormack
- Division of Urology, Department of Surgery, Université de Montréal, Hôpital Saint-Luc du CHUM, Montreal, QC
| | - Alain Duclos
- Division of Urology, Department of Surgery, Université de Montréal, Hôpital Saint-Luc du CHUM, Montreal, QC
| | - Mathieu Latour
- Department of Pathology, Université de Montréal, Hôpital Saint-Luc du CHUM, Montreal, QC
| | | | - Daniel Liberman
- Division of Urology, Department of Surgery, Université de Montréal, Hôpital Saint-Luc du CHUM, Montreal, QC
| | | | | | - Luc Valiquette
- Division of Urology, Department of Surgery, Université de Montréal, Hôpital Saint-Luc du CHUM, Montreal, QC
| | - Kevin Zorn
- Division of Urology, Department of Surgery, Université de Montréal, Hôpital Saint-Luc du CHUM, Montreal, QC
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Bacterial sepsis following prostatic biopsy. Int Urol Nephrol 2012; 44:1055-63. [PMID: 22371127 DOI: 10.1007/s11255-012-0145-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
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Taylor AK, Zembower TR, Nadler RB, Scheetz MH, Cashy JP, Bowen D, Murphy AB, Dielubanza E, Schaeffer AJ. Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol 2012; 187:1275-9. [PMID: 22341272 DOI: 10.1016/j.juro.2011.11.115] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE We evaluated targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound guided prostate biopsy based on rectal swab culture results. MATERIALS AND METHODS From July 2010 to March 2011 we studied differences in infectious complications in men who received targeted vs standard empirical ciprofloxacin prophylaxis before transrectal ultrasound guided prostate biopsy. Targeted prophylaxis used rectal swab cultures plated on selective media containing ciprofloxacin to identify fluoroquinolone resistant bacteria. Patients with fluoroquinolone susceptible organisms received ciprofloxacin while those with fluoroquinolone resistant organisms received directed antimicrobial prophylaxis. We identified men with infectious complications within 30 days after transrectal ultrasound guided prostate biopsy using the electronic medical record. RESULTS A total of 457 men underwent transrectal ultrasound guided prostate biopsy, and of these men 112 (24.5%) had rectal swab obtained while 345 (75.5%) did not. Among those who received targeted prophylaxis 22 (19.6%) men had fluoroquinolone resistant organisms. There were no infectious complications in the 112 men who received targeted antimicrobial prophylaxis, while there were 9 cases (including 1 of sepsis) among the 345 on empirical therapy (p=0.12). Fluoroquinolone resistant organisms caused 7 of these infections. The total cost of managing infectious complications in patients in the empirical group was $13,219. The calculated cost of targeted vs empirical prophylaxis per 100 men undergoing transrectal ultrasound guided prostate biopsy was $1,346 vs $5,598, respectively. Cost-effectiveness analysis revealed that targeted prophylaxis yielded a cost savings of $4,499 per post-transrectal ultrasound guided prostate biopsy infectious complication averted. Per estimation, 38 men would need to undergo rectal swab before transrectal ultrasound guided prostate biopsy to prevent 1 infectious complication. CONCLUSIONS Targeted antimicrobial prophylaxis was associated with a notable decrease in the incidence of infectious complications after transrectal ultrasound guided prostate biopsy caused by fluoroquinolone resistant organisms as well as a decrease in the overall cost of care.
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Affiliation(s)
- Aisha K Taylor
- Department of Urology, Northwestern University Feinberg School of Medicine, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL 60611, USA
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Pinkhasov GI, Lin YK, Palmerola R, Smith P, Mahon F, Kaag MG, Dagen JE, Harpster LE, Reese CT, Raman JD. Complications following prostate needle biopsy requiring hospital admission or emergency department visits - experience from 1000 consecutive cases. BJU Int 2012; 110:369-74. [DOI: 10.1111/j.1464-410x.2011.10926.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ramaswamy K, Shah O. Antibiotic Prophylaxis After Uncomplicated Ureteroscopic Stone Treatment: Is There a Difference? J Endourol 2012; 26:122-5. [DOI: 10.1089/end.2011.0360] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Krishna Ramaswamy
- Department of Urology, New York University School of Medicine, New York, New York
| | - Ojas Shah
- Department of Urology, New York University School of Medicine, New York, New York
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Rosario DJ, Lane JA, Metcalfe C, Donovan JL, Doble A, Goodwin L, Davis M, Catto JWF, Avery K, Neal DE, Hamdy FC. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ 2012; 344:d7894. [PMID: 22232535 PMCID: PMC3253765 DOI: 10.1136/bmj.d7894] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To measure the effect of the adverse events within 35 days of transrectal ultrasound guided biopsy from the perspective of asymptomatic men having prostate specific antigen (PSA) testing; to assess early attitude to re-biopsy; to estimate healthcare resource use associated with adverse events due to biopsy; and to develop a classification scheme for reporting adverse events after prostate biopsy. DESIGN Prospective cohort study (Prostate Biopsy Effects: ProBE) nested within Prostate Testing for Cancer and Treatment (ProtecT) study. Participants Between 1999 and 2008, 227,000 community dwelling men aged 50-69 years were identified at 352 practices and invited to counselling about PSA testing. 111,148 attended a nurse led clinic in the community, and 10,297 with PSA concentrations of 3-20 ng/mL were offered biopsy within ProtecT. Between February 2006 and May 2008, 1147/1753 (65%) eligible men (mean age 62.1 years, mean PSA 5.4 ng/mL) having 10 core transrectal ultrasound guided biopsy under antibiotic cover in the context of ProtecT were recruited to the ProBE study. OUTCOME MEASURES Purpose designed questionnaire administered at biopsy and 7 and 35 days after the procedure to measure frequency and effect of symptoms related to pain, infection, and bleeding; patients' attitude to repeat biopsy assessed immediately after biopsy and 7 days later; participants' healthcare resource use within 35 days of biopsy evaluated by questionnaire, telephone follow-up, and medical note review; each man's adverse event profile graded according to symptoms and healthcare use. RESULTS Pain was reported by 429/984 (43.6%), fever by 172/985 (17.5%), haematuria by 642/976 (65.8%), haematochezia by 356/967 (36.8%), and haemoejaculate by 605/653 (92.6%) men during the 35 days after biopsy. Fewer men rated these symptoms as a major/moderate problem-71/977 (7.3%) for pain, 54/981 (5.5%) for fever, 59/958 (6.2%) for haematuria, 24/951 (2.5%) for haematochezia, and 172/646 (26.6%) for haemoejaculate. Immediately after biopsy, 124/1142 (10.9%, 95% confidence interval 9.2 to 12.8) men reported that they would consider further biopsy a major or moderate problem: seven days after biopsy, this proportion had increased to 213/1085 (19.6%, 17.4% to 22.1%). A negative attitude to repeat biopsy was associated with unfavourable experience after the first biopsy, particularly pain at biopsy (odds ratio 8.2, P<0.001) and symptoms related to infection (7.9, P<0.001) and bleeding (4.2, P<0.001); differences were evident between centres (P<0.001). 119/1147 (10.4%, 8.7% to 12.3%) men reported consultation with a healthcare professional (usually their general practitioner), most commonly for infective symptoms. Complete data for all index symptoms at all time points were available in 851 participants. Symptoms and healthcare use could be used to grade these men as follows: grade 0 (no symptoms/contact) 18 (2.1%, 1.3% to 3.3%); grade 1 (minor problem/no contact) 550 (64.6%, 61.4% to 67.8%); grade 2 (moderate/major problem or contact) 271 (31.8%, 28.8% to 35.1%); grade 3 (hospital admission) 12 (1.4%, 0.8% to 2.4%); and grade 4 (death) 0. Grade of adverse event was associated with an unfavourable attitude to repeat biopsy (Kendall's τ-b ordinal by ordinal 0.29, P<0.001). CONCLUSION This study with a high response rate of 89% at 35 days in men undergoing biopsy in the context of a randomised controlled trial has shown that although prostate biopsy is well tolerated by most men, it is associated with significant symptoms in a minority and affects attitudes to repeat biopsy and primary care resource use. These findings will inform men who seek PSA testing for detection of prostate cancer and assist their physicians during counselling about the potential risks and effect of biopsy. Variability in the adverse event profile between centres suggests that patients' outcomes could be improved and healthcare use reduced with more effective administration of local anaesthetic and antibiotics. Trial registration Current Controlled Trials ISRCTN20141297.
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Affiliation(s)
- Derek J Rosario
- Academic Urology Unit, Department of Oncology, Royal Hallamshire Hospital, University of Sheffield, Sheffield S10 2JF, UK.
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93
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Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schröder FH, Roobol MJ. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 2012; 61:1110-4. [PMID: 22244150 DOI: 10.1016/j.eururo.2011.12.058] [Citation(s) in RCA: 229] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 12/28/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND The complications of prostate needle biopsy (PNB) are important when considering the benefits and harms of prostate cancer screening. Studies from the United States and Canada have recently reported increasing numbers of hospitalizations for infectious complications after PNB. OBJECTIVE Examine the risk of infectious complications and hospital admissions after PNB in a European screening trial. DESIGN, SETTING, AND PARTICIPANTS From 1993 to 2011, 10 474 PNBs were performed in the European Randomized Study of Screening for Prostate Cancer (Rotterdam section). Prophylaxis originally consisted of trimethoprim-sulfamethoxazole. Beginning in 2008, it was changed to ciprofloxacin. MEASUREMENTS Febrile complications and hospital admissions were assessed by questionnaires 2 wk after PNB. Logistic regression was used to identify risk factors for biopsy-related fever and hospital admission. RESULTS AND LIMITATIONS Fever and hospital admission were reported on 392 of 9241 questionnaires (4.2%) and 78 of 9198 questionnaires (0.8%), respectively. Although most fevers were managed on an outpatient basis, 81% of hospital admissions were for infection. Of the 56 available blood cultures, 34 were positive with Escherichia coli as the predominant organism. On multivariable analysis, prostate enlargement and diabetes were significantly associated with an increased risk of fever after PNB, whereas later year of biopsy was the only factor significantly associated with an increased risk of hospital admission. CONCLUSIONS In a European screening trial, <5% PNBs resulted in febrile complications. Significant risk factors included diabetes and prostatic enlargement. Although most fevers were managed on an outpatient basis, infection remained the leading cause of hospital admission after PNB. Consistent with prior international reports, the frequency of hospital admissions after PNB significantly increased over time. Nevertheless, the absolute frequency of hospital admissions related to PNB was low and should not dissuade healthy men who would benefit from early prostate cancer diagnosis from undergoing biopsy when clinically indicated.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA.
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94
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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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95
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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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96
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Minamida S, Satoh T, Tabata K, Kimura M, Tsumura H, Kurosaka S, Matsumoto K, Fujita T, Iwamura M, Baba S. Prevalence of Fluoroquinolone-resistant Escherichia coli Before and Incidence of Acute Bacterial Prostatitis After Prostate Biopsy. Urology 2011; 78:1235-9. [DOI: 10.1016/j.urology.2011.07.1392] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/11/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
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97
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Adibi M, Pearle MS, Lotan Y. Cost-effectiveness of standard vs intensive antibiotic regimens for transrectal ultrasonography (TRUS)-guided prostate biopsy prophylaxis. BJU Int 2011; 110:E86-91. [DOI: 10.1111/j.1464-410x.2011.10768.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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98
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Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: data from SEER-Medicare. J Urol 2011; 186:1830-4. [PMID: 21944136 PMCID: PMC9840843 DOI: 10.1016/j.juro.2011.06.057] [Citation(s) in RCA: 448] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Indexed: 01/17/2023]
Abstract
PURPOSE More than 1 million prostate biopsies are performed annually among Medicare beneficiaries. We determined the risk of serious complications requiring hospitalization. We hypothesized that with emerging multidrug resistant organisms there may be an increasing risk of infectious complications. MATERIALS AND METHODS In a 5% random sample of Medicare participants in SEER (Surveillance, Epidemiology and End Results) regions from 1991 to 2007 we compared 30-day hospitalization rates and ICD-9 primary diagnosis codes for admissions between 17,472 men who underwent prostate biopsy and a random sample of 134,977 controls. Multivariate logistic and Poisson regression were used to examine the risk and predictors of serious infectious and noninfectious complications with time. RESULTS The 30-day hospitalization rate was 6.9% within 30 days of prostate biopsy, which was substantially higher than the 2.7% in the control population. After adjusting for age, race, SEER region, year and comorbidities prostate biopsy was associated with a 2.65-fold (95% CI 2.47-2.84) increased risk of hospitalization within 30 days compared to the control population (p <0.0001). The risk of infectious complications requiring hospitalization after biopsy was significantly greater in more recent years (p(trend) = 0.001). Among men undergoing biopsy, later year, nonwhite race and higher comorbidity scores were significantly associated with an increased risk of infectious complications. CONCLUSIONS The risk of hospitalization within 30 days of prostate biopsy was significantly higher than in a control population. Infectious complications after prostate biopsy have increased in recent years while the rate of serious noninfectious complications is relatively stable. Careful patient selection for prostate biopsy is essential to minimize the potential harms.
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Affiliation(s)
- Stacy Loeb
- Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
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99
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Williams SB, Salami S, Regan MM, Ankerst DP, Wei JT, Rubin MA, Thompson IM, Sanda MG. Selective detection of histologically aggressive prostate cancer: an Early Detection Research Network Prediction model to reduce unnecessary prostate biopsies with validation in the Prostate Cancer Prevention Trial. Cancer 2011; 118:2651-8. [PMID: 22006057 DOI: 10.1002/cncr.26396] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 03/28/2011] [Accepted: 04/11/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Limited survival benefit and excess treatment because of prostate-specific antigen (PSA) screening in randomized trials suggests a need for more restricted selection of prostate biopsy candidates by discerning risk of histologically aggressive versus indolent cancer before biopsy. METHODS Subjects undergoing first prostate biopsy enrolled in a multicenter, prospective cohort of the National Cancer Institute Early Detection Research Network (N = 635) were analyzed to develop a model for predicting histologically aggressive prostate cancers. The control arm of the Prostate Cancer Prevention Trial (N = 3833) was used to validate the generalization of the predictive model. RESULTS The Early Detection Research Network cohort was comprised of men among whom 57% had no cancer, 14% had indolent cancer, and 29% had aggressive cancer. Age, body mass index, family history of prostate cancer, abnormal digital rectal examination (DRE), and PSA density (PSAD) were associated with aggressive cancer (all P < .001). The Early Detection Research Network model outperformed PSA alone in predicting aggressive cancer (area under the curve [AUC] = 0.81 vs 0.71, P < .01). Model validation in the Prostate Cancer Prevention Trial cohort accurately identified men at low (<10%) risk of aggressive cancer for whom biopsy could be averted (AUC = 0.78; 95% confidence interval, 0.75-0.80). Under criteria from the Early Detection Research Network model, prostate biopsy can be restricted to men with PSAD >0.1 ng/mL/cc or abnormal DRE. When PSAD is <0.1 ng/mL/cc, family history or obesity can identify biopsy candidates. CONCLUSIONS A predictive model incorporating age, family history, obesity, PSAD, and DRE elucidates criteria whereby ¼ of prostate biopsies can be averted while retaining high sensitivity in detecting aggressive prostate cancer.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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100
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Steensels D, Slabbaert K, De Wever L, Vermeersch P, Van Poppel H, Verhaegen J. Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy--should we reassess our practices for antibiotic prophylaxis? Clin Microbiol Infect 2011; 18:575-81. [PMID: 21958149 DOI: 10.1111/j.1469-0691.2011.03638.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although the estimate of the incidence of sepsis following transrectal ultrasound-guided prostate biopsy (TRUSPB) is low, fluoroquinolone-resistant infections after prostate biopsy are being increasingly noted. This study was aimed at determining the prevalence of faecal carriage of fluoroquinolone-resistant Escherichia coli strains before TRUSPB and at evaluating potential predisposing risk factors. The incidence of sepsis after prostate biopsy was determined, and our routine practice for antibiotic prophylaxis for TRUSPB was evaluated. A prospective study was conducted in 342 consecutive patients undergoing prostate biopsy between December 2009 and July 2010. Before TRUSPB, a rectal swab was cultured. The correlation between the presence of fluoroquinolone-resistant strains and plausible risk factors was investigated by the use of a questionnaire. Of the 236 patients included, 22.0% (52/236) harboured ciprofloxacin-resistant E. coli strains. The use of fluoroquinolones in the 6 months before biopsy was associated with an increased risk of faecal carriage of fluoroquinolone-resistant E. coli strains (p <0.01). Faecal carriage of fluoroquinolone-resistant E. coli strains was an important risk factor for infectious complications after TRUSPB (p <0.01). In conclusion, a significant number of patients have faecal carriage of fluoroquinolone-resistant E. coli strains (22.0%) before TRUSPB. The use of fluoroquinolones in the previous 6 months before biopsy is a risk factor for faecal carriage of fluoroquinolone-resistant E. coli strains and for infectious complications after TRUSPB. Hence, the universal administration of fluoroquinolones should be reconsidered.
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Affiliation(s)
- D Steensels
- Department of Laboratory Medicine--Microbiology, Universitaire Ziekenhuizen Leuven Gasthuisberg, Leuven, Belgium.
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