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Salcher-Konrad M, Nguyen M, Savovic J, Higgins JPT, Naci H. Treatment Effects in Randomized and Nonrandomized Studies of Pharmacological Interventions: A Meta-Analysis. JAMA Netw Open 2024; 7:e2436230. [PMID: 39331390 PMCID: PMC11437387 DOI: 10.1001/jamanetworkopen.2024.36230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2024] Open
Abstract
Importance Randomized clinical trials (RCTs) are widely regarded as the methodological benchmark for assessing clinical efficacy and safety of health interventions. There is growing interest in using nonrandomized studies to assess efficacy and safety of new drugs. Objective To determine how treatment effects for the same drug compare when evaluated in nonrandomized vs randomized studies. Data Sources Meta-analyses published between 2009 and 2018 were identified in MEDLINE via PubMed and the Cochrane Database of Systematic Reviews. Data analysis was conducted from October 2019 to July 2024. Study Selection Meta-analyses of pharmacological interventions were eligible for inclusion if both randomized and nonrandomized studies contributed to a single meta-analytic estimate. Data Extraction and Synthesis For this meta-analysis using a meta-epidemiological framework, separate summary effect size estimates were calculated for nonrandomized and randomized studies within each meta-analysis using a random-effects model and then these estimates were compared. The reporting of this study followed the Guidelines for Reporting Meta-Epidemiological Methodology Research and relevant portions of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Main Outcome and Measures The primary outcome was discrepancies in treatment effects obtained from nonrandomized and randomized studies, as measured by the proportion of meta-analyses where the 2 study types disagreed about the direction or magnitude of effect, disagreed beyond chance about the effect size estimate, and the summary ratio of odds ratios (ROR) obtained from nonrandomized vs randomized studies combined across all meta-analyses. Results A total of 346 meta-analyses with 2746 studies were included. Statistical conclusions about drug benefits and harms were different for 130 of 346 meta-analyses (37.6%) when focusing solely on either nonrandomized or randomized studies. Disagreements were beyond chance for 54 meta-analyses (15.6%). Across all meta-analyses, there was no strong evidence of consistent differences in treatment effects obtained from nonrandomized vs randomized studies (summary ROR, 0.95; 95% credible interval [CrI], 0.89-1.02). Compared with experimental nonrandomized studies, randomized studies produced on average a 19% smaller treatment effect (ROR, 0.81; 95% CrI, 0.68-0.97). There was increased heterogeneity in effect size estimates obtained from nonrandomized compared with randomized studies. Conclusions and Relevance In this meta-analysis of treatment effects of pharmacological interventions obtained from randomized and nonrandomized studies, there was no overall difference in effect size estimates between study types on average, but nonrandomized studies both overestimated and underestimated treatment effects observed in randomized studies and introduced additional uncertainty. These findings suggest that relying on nonrandomized studies as substitutes for RCTs may introduce additional uncertainty about the therapeutic effects of new drugs.
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Affiliation(s)
- Maximilian Salcher-Konrad
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- World Health Organization Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG)/Austrian National Public Health Institute, Vienna, Austria
| | - Mary Nguyen
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of Family and Community Medicine, University of California, San Francisco
| | - Jelena Savovic
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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Bovo A, Kwiatkowski M, Manka L, Wetterauer C, Fux CA, Cattaneo M, Wyler SF, Prause L. Comparison of ciprofloxacin versus fosfomycin versus fosfomycin plus trimethoprim/sulfamethoxazole for preventing infections after transrectal prostate biopsy. World J Urol 2024; 42:356. [PMID: 38806739 PMCID: PMC11133158 DOI: 10.1007/s00345-024-05048-4] [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: 01/23/2024] [Accepted: 05/06/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND To evaluate antibiotic prophylaxis in transrectal prostate biopsies due to the recommendation of the European Medicines Agency (EMA): We describe our single center experience switching from ciprofloxacin to fosfomycin trometamol (FMT) alone and to an augmented prophylaxis combining fosfomycin and trimethoprim/sulfamethoxazole (TMP/SMX). METHODS Between 01/2019 and 12/2020 we compared three different regimes. The primary endpoint was the clinical diagnosis of an infection within 4 weeks after biopsy. We enrolled 822 men, 398 (48%) of whom received ciprofloxacin (group-C), 136 (16.5%) received FMT (group-F) and 288 (35%) received the combination of TMP/SMX and FMT (group-BF). RESULTS Baseline characteristics were similar between groups. In total 37/398 (5%) postinterventional infections were detected, of which 13/398 (3%) vs 18/136 (13.2%) vs 6/288 (2.1%) were detected in group-C, group-F and group-BF respectively. The relative risk of infectious complication was 1.3 (CI 0.7-2.6) for group-C vs. group-BF and 2.8 (CI 1.4-5.7) for group-F vs. group-BF respectively. CONCLUSION The replacement of ciprofloxacin by fosfomycin alone resulted in a significant increase of postinterventional infections, while the combination of FMT and TMP/SMX had a comparable infection rate to FQ without apparent adverse events. Therefore, this combined regimen of FMT and TMP/SMX is recommended.
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Affiliation(s)
- Alberto Bovo
- Department of Urology, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Maciej Kwiatkowski
- Department of Urology, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland
- Medical Faculty, University Hospital Basel, Basel, Switzerland
- Department of Urology, Academic Hospital Braunschweig, Brunswick, Germany
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Brunswick, Germany
- Department of Urology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany
| | - Christian Wetterauer
- Medical Faculty, University Hospital Basel, Basel, Switzerland
- Department of Urology, University Hospital Basel, Basel, Switzerland
- Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, 3500, Krems, Austria
| | - Christoph Andreas Fux
- Department of Infectious Diseases and Hospital Hygiene, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Marco Cattaneo
- Department of Clinical Research, University of Basel, 4001, Basel, Switzerland
| | - Stephen F Wyler
- Department of Urology, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland
- Medical Faculty, University Hospital Basel, Basel, Switzerland
| | - Lukas Prause
- Department of Urology, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland
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Dell’Atti L, Slyusar V, Ronchi P, Manno S, Cambise C. Transrectal Prostate Biopsy Approach in Men Undergoing Kidney Transplant: A Retrospective Cohort Study at Three Referral Academic Centers. Diagnostics (Basel) 2024; 14:266. [PMID: 38337782 PMCID: PMC10855598 DOI: 10.3390/diagnostics14030266] [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: 01/09/2024] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Currently, there are no studies evaluating the feasibility of a prostate biopsy approach in men undergoing a kidney transplant (KT). Owing to this evidence, we planned a retrospective population-based study to evaluate our experience of a transrectal prostate biopsy (TR-PB) approach and studied the impact on the complication rate and outcomes in patients undergoing KT with suspected prostate cancer (PCa). METHODS We collected data from KT patients who underwent PB with a transrectal approach. One week and two weeks after the PB, patients' information was collected regarding possible complications during the post-biopsy period. RESULTS A total of 121 patients were included in this study. Among them, Group 1 was composed of 59 patients undergoing TR-PB with an ultrasound (US) standard technique, and Group 2 consisted of 62 patients undergoing TR-PB with an MRI-US cognitive technique. We observed a 28.9% Clavien-Dindo grade ≤ 2 of early side effect rates (mostly rectal bleeding and other minor hematuria), with a very low rate of hospital re-admission for acute urinary retention (3.3%); only one man required hospitalization for rectal bleeding, and there were no major complications. CONCLUSIONS We can affirm that TR-PB can be a safe procedure with a low risk of severe complications when performed by skilled specialists with a standardized procedural pathway.
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Affiliation(s)
- Lucio Dell’Atti
- Department of Urology, University-Hospital of Marche, 60126 Ancona, Italy;
| | - Viktoria Slyusar
- Pain Therapy Center, Division of Anesthesia and Intensive Care, University-Hospital of Marche, 60126 Ancona, Italy;
| | - Piero Ronchi
- Department of Urology, University-Hospital of Marche, 60126 Ancona, Italy;
| | - Stefano Manno
- Department of Urology, University-Hospital Renato Dulbecco, 88100 Catanzaro, Italy;
| | - Chiara Cambise
- Department of Emergency, University-Hospital Gemelli IRCSS, 00168 Roma, Italy;
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Kim HY, Lim D, Choi YH, Yoo JM, Lee DS, Lee SJ. Efficacy of fosfomycin compared to second generation cephalosporin flumarin as antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: a single center retrospective study. BMC Urol 2023; 23:211. [PMID: 38114968 PMCID: PMC10729332 DOI: 10.1186/s12894-023-01391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Fluoroquinolone has been the historic choice of antimicrobial prophylaxis for transrectal ultrasound (TRUS) guided prostate biopsy. However, increased fluoroquinolone resistance and recent restrictions of its use for antimicrobial prophylaxis has led to the emergence of alternative agents for antimicrobial prophylaxis for TRUS guided prostate biopsy including fosfomycin and cephalosporins. This study aimed to compare the efficacy of fosfomycin and a second-generation cephalosporin flumarin as alternative antimicrobials for TRUS-guided prostate biopsy in terms of the incidence of infectious complications after TRUS-guided prostate biopsy. METHODS A retrospective chart review of all patients who underwent TRUS-guided prostate biopsy between November 2009 to January 2023 was undertaken. Comparison of baseline characteristics and the incidence of infectious complications was done between those who received fosfomycin as antimicrobial prophylaxis for TRUS-guided prostate biopsy and those who received flumarin. Multivariate logistic regression analysis was conducted to identify risk factors for infectious complications after TRUS-guided prostate biopsy. RESULTS Of 2,900 patients identified as eligible candidates for analysis, 333 (11.5%) received fosfomycin and 2,567 (88.5%) received flumarin. The overall rate of infectious complications was approximately 3% lower in patients who received fosfomycin, although such difference did not reach statistical significance (5.7% vs. 8.6%, p = 0.074). Multivariate logistic regression analysis showed that history of operation done under general anaesthesia within six months of the biopsy (odds ratio [OR]: 2.216; 95% confidence interval [CI]: 1.042-4.713; p = 0.039) and history of prior antimicrobial use within six months (OR: 1.457; 95% CI: 1.049-2.024; p = 0.025) were significant risk factors for infectious complications after TRUS-guided prostate biopsy. CONCLUSION Fosfomycin was comparable to second-generation cephalosporin flumarin in preventing infectious complications after TRUS-guided prostate biopsy. Coupled with its properties such as ease of administration, low adverse effects, low resistance rate, and low collateral damage, fosfomycin might be an attractive alternative antimicrobial prophylaxis for TRUS-guided prostate biopsy.
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Affiliation(s)
- Hee Youn Kim
- Department of Urology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Seoul, 16247, Republic of Korea
| | - Daehyun Lim
- Department of Urology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Seoul, 16247, Republic of Korea
| | - Young Hyo Choi
- Department of Urology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Seoul, 16247, Republic of Korea
| | - Je Mo Yoo
- Department of Urology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Seoul, 16247, Republic of Korea
| | - Dong Sup Lee
- Department of Urology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Seoul, 16247, Republic of Korea
| | - Seung-Ju Lee
- Department of Urology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Seoul, 16247, Republic of Korea.
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Alberti A, Nicoletti R, Polverino P, Rivetti A, Dibilio E, Resta GR, Makrides P, Caneschi C, Cifarelli A, D’Amico A, Moscardi L, Lo Re M, Peschiera F, Gallo ML, Pecoraro A, Sebastianelli A, Masieri L, Gacci M, Serni S, Campi R, Sessa F. Morbidity of Transrectal MRI-Fusion Targeted Prostate Biopsy at a Tertiary Referral Academic Centre: An Audit to Guide the Transition to the Transperineal Approach. Cancers (Basel) 2023; 15:5798. [PMID: 38136344 PMCID: PMC10742076 DOI: 10.3390/cancers15245798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Despite transrectal prostate biopsy (TRPB) being still widespread globally, the EAU Guidelines strongly recommend the transperineal approach, due to the reported lower infectious risk. Our study aims to evaluate the impact of a standardized clinical pathway for TRPB on post-operative complications. We prospectively collected data from all patients undergoing mpMRI-targeted TRPB at our Academic Centre from January 2020 to December 2022. All patients followed a standardized, structured multistep pathway. Post-procedural complications were collected and classified according to the Clavien-Dindo (CD) Classification. Among 458 patients, post-procedural adverse events were reported by 203 (44.3%), of which 161 (35.2%) experienced CD grade 1 complications (hematuria [124, 27.1%], hematochezia [22, 4.8%], hematospermia [14, 3.1%], or a combination [20, 4.4%]), and 45 (9.0%) reported CD grade 2 complications (acute urinary retention or hematuria needing catheterization, as well as urinary tract infections, of which 2 cases required hospitalization). No major complications, including sepsis, were observed. At uni- and multivariable analysis, age > 70 years and BMI > 25 kg/ m2 for patients were identified as predictors of post-operative complications. The results of our study confirm that TRPB is a safe and cost-effective procedure with a low risk of severe adverse events in experienced hands and following a standardized pathway.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, 50134 Florence, Italy; (A.A.); (P.M.); (R.C.)
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Cai T, Novelli A, Tascini C, Stefani S. Rediscovering the value of fosfomycin trometamol in the era of antimicrobial resistance: A systematic review and expert opinion. Int J Antimicrob Agents 2023; 62:106983. [PMID: 37748624 DOI: 10.1016/j.ijantimicag.2023.106983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
The worldwide prevalence of uncomplicated lower urinary tract infections (uUTIs) caused by multidrug-resistant Escherichia coli is increasing. To address this emergency, international guidelines recommend reducing administration of fluoroquinolones, in the context of growing resistance and the long-lasting and potentially disabling side effects of these drugs. The favoured drug to replace fluoroquinolones is fosfomycin trometamol (FT), a well-known derivate of phosphonic acid with broad-spectrum activity against Gram-negative and Gram-positive bacteria, including multidrug-resistant (MDR) strains. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) recently reduced the susceptibility breakpoint for E. coli from 32 mg/L to 8 mg/L regarding FT used for uUTIs. This might lead to increased appropriate use of oral fosfomycin target therapy against E. coli and other microorganisms, and may be associated with a high likelihood of success. For species such as Klebsiella spp, particularly MDR strains, the absence of clinical breakpoints might lead to reduced use of oral fosfomycin, particularly if minimum inhibitory concentration is not available. To address this issue, this review presents an overview of the preclinical evidence on the activity of FT, and a systematic review of the clinical activity of FT in uUTIs in women, and in the prevention of infectious complications after prostate biopsy. The findings indicate that the safety and microbiological and clinical effectiveness of a single oral dose of FT are similar to that for comparator regimens with longer treatment schedules in women with uUTI, and FT can be considered a viable alternative to fluoroquinolones for antimicrobial prophylaxis in prostate biopsy. These observations and a broad clinical experience support the empirical use of FT for treating uUTI and indicate that FT is a promising candidate to effectively counteract antibiotic-resistant uUTIs throughout Europe.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Carlo Tascini
- Department of Medicine (DAME), Infectious Diseases Clinic, University of Udine, Udine, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Gu HM, Gu JS, Chung HS, Jung SI, Kwon D, Kim MH, Jung JH, Han MA, Kang SJ, Hwang EC, Dahm P. Fosfomycin for Antibiotic Prophylaxis in Men Undergoing a Transrectal Prostate Biopsy: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:911. [PMID: 37241143 PMCID: PMC10221023 DOI: 10.3390/medicina59050911] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: To assess the effects of fosfomycin compared with other antibiotics as a prophylaxis for urinary tract infections (UTIs) in men undergoing transrectal prostate biopsies. Materials and Methods: We searched multiple databases and trial registries without publication language or status restrictions until 4 January 2022. Parallel-group randomized controlled trials (RCTs) and non-randomized studies (NRS) were included. The primary outcomes were febrile UTI, afebrile UTI, and overall UTI. We used GRADE guidance to rate the certainty of evidence of RCTs and NRSs. The protocol was registered with PROSPERO (CRD42022302743). Results: We found data on five comparisons; however, this abstract focuses on the primary outcomes of the two most clinically relevant comparisons. Regarding fosfomycin versus fluoroquinolone, five RCTs and four NRSs with a one-month follow-up were included. Based on the RCT evidence, fosfomycin likely resulted in little to no difference in febrile UTIs compared with fluoroquinolone. This difference corresponded to four fewer febrile UTIs per 1000 patients. Fosfomycin likely resulted in little to no difference in afebrile UTIs compared with fluoroquinolone. This difference corresponded to 29 fewer afebrile UTIs per 1000 patients. Fosfomycin likely resulted in little to no difference in overall UTIs compared with fluoroquinolone. This difference corresponded to 35 fewer overall UTIs per 1000 patients. Regarding fosfomycin and fluoroquinolone combined versus fluoroquinolone, two NRSs with a one- to three-month follow-up were included. Based on the NRS evidence, fosfomycin and fluoroquinolone combined may result in little to no difference in febrile UTIs compared with fluoroquinolone. This difference corresponded to 16 fewer febrile UTIs per 1000 patients. Conclusions: Compared with fluoroquinolone, fosfomycin or fosfomycin and fluoroquinolone combined may have a similar prophylactic effect on UTIs after a transrectal prostate biopsy. Given the increasing fluoroquinolone resistance and its ease to use, fosfomycin may be a good option for antibiotic prophylaxis.
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Affiliation(s)
- Hui Mo Gu
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Jin Seok Gu
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Dongdeuk Kwon
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea;
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea;
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea;
| | - Seung Ji Kang
- Department of Infectious Disease, Chonnam National University Medical School, Gwangju 61469, Republic of Korea;
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Hwasun 58128, Republic of Korea; (H.M.G.); (J.S.G.); (H.S.C.); (S.I.J.)
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA;
- Minneapolis VA Health Care System, Specialty Care, Minneapolis, MN 55417, USA
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Pilatz A, Alidjanov J, Bonkat G, Wagenlehner F. [Prostate biopsy-infection prophylaxis and patient preparation]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:459-463. [PMID: 36882551 DOI: 10.1007/s00120-023-02065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/09/2023]
Abstract
Prostate biopsy has been at the center of controversy in recent years due to high infection complications associated with the transrectal route and the withdrawal of authorization for fluoroquinolones and fosfomycin trometemol as prophylaxis. The Urological Infections Guideline Group of the European Association of Urology (EAU) recently published a meta-analysis in two parts based on randomized controlled trials (RCTs) and annually updates the data for the EAU guidelines. The meta-analyses show that transperineal prostate biopsy is associated with significantly fewer infectious complications than transrectal biopsy and should therefore be preferred. If transrectal biopsy is still used, then intrarectal cleansing with povidone-iodine and antibiotic prophylaxis should be used. Antibiotic prophylaxis strategies include targeted prophylaxis after sensitivity testing of the rectal flora, augmented prophylaxis with several antibiotics and empirical monoprophylaxis. Data from RCTs are available for aminoglycosides and third-generation cephalosporins.
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Affiliation(s)
- A Pilatz
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
| | - J Alidjanov
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | | | - F Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
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Labi AK, Obeng-Nkrumah N, Dayie NTKD, Addo BM, Osei MM, Fenny A, Egyir B, Mensah JE. Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy. JAC Antimicrob Resist 2022; 4:dlac113. [PMID: 36349243 PMCID: PMC9636584 DOI: 10.1093/jacamr/dlac113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B) Objectives We investigated the relationship between carriage of FQ-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications. Methods From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors. Results Overall, 86.4% (n = 312/361) and 62.6% (n = 226/361) of patients carried FQ-resistant and ESBL-producing E. coli and K. pneumoniae complex, respectively. Approximately 60% (n = 289/483) of the FQ-resistant and 66.0% (n = 202/306) of the ESBL-positive isolates exhibited in vitro resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal E. coli and K. pneumoniae complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% (n = 11/361), with an overall high probability (96.9%) of staying free of infections within the 30 day period post-TRUS-B. Antibiotic use in the previous 3 months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive E. coli and K. pneumoniae complex comprised an independent risk factor for post-biopsy infectious complications. Conclusions The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.
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Affiliation(s)
- Appiah-Korang Labi
- Department of Microbiology, Korle-Bu Teaching Hospital , PO Box 77, Accra , Ghana
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences , PO Box KB 143, Accra , Ghana
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, University of Ghana Medical School , PO Box KB 143, Accra , Ghana
| | - Ben Molai Addo
- Department of Surgery, Urology Clinic, Korle-Bu Teaching Hospital , PO Box 77, Accra , Ghana
| | - Mary-Magdalene Osei
- Department of Medical Microbiology, University of Ghana Medical School , PO Box KB 143, Accra , Ghana
| | - Ama Fenny
- Institute of Statistical, Social and Economic Research, University of Ghana , PO Box LG74, Accra , Ghana
| | - Beverly Egyir
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research , University of Ghana, P. O. Box LG 581, Accra , Ghana
| | - James Edward Mensah
- Department of Surgery University of Ghana Medical School , PO Box 4236, Accra , Ghana
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Yu SH, Jung SI, Ryu JW, Kim MS, Chung HS, Hwang EC, Kwon DD. Comparison of amikacin with fosfomycin as an add-on to ciprofloxacin for antibiotic prophylaxis in transrectal prostate biopsy: A single-center retrospective study. Investig Clin Urol 2022; 63:663-670. [PMID: 36347556 PMCID: PMC9643727 DOI: 10.4111/icu.20220147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/09/2022] [Accepted: 07/18/2022] [Indexed: 01/03/2024] Open
Abstract
PURPOSE To assess the effect of ciprofloxacin (CP) and fosfomycin compared with CP and amikacin in patients with a fluoroquinolone (FQ)-resistant rectal flora who have undergone transrectal ultrasound-guided prostate biopsy (TRUSPB). MATERIALS AND METHODS In total, 516 patients with FQ-resistant rectal flora based on rectal swab cultures were divided into two groups according to prophylactic antibiotics. Patients in both groups were administered CP (400 mg, intravenous [IV], twice daily) on the same day as TRUSPB and 1 day after biopsy. The amikacin group (n=260) was administered a single injection of amikacin (1 g, IV) 1 hour before TRUSPB, whereas the fosfomycin group (n=256) was administered fosfomycin (3 g, orally) the night before the procedure. The primary endpoint was the rate of infectious complications in the two groups. RESULTS Overall, 13 patients (2.5%) reported infectious complications: 12 patients (4.62%) in the amikacin group compared with 1 patient (0.39%) in the fosfomycin group (risk ratio, 0.09; 95% confidence interval [CI], 0.01-0.65), respectively, which was a statistically significant difference (p=0.017). This corresponds to a number needed to treat of 24 patients (95% CI, 15-65) to prevent one infectious complication. In the multivariate analysis to assess variables related to infectious complications, prophylactic antibiotics with added fosfomycin was associated with infectious complications (odds ratio, 0.060; 95% CI, 0.008-0.459). CONCLUSIONS In the era of FQ resistance, CP and fosfomycin may reduce the rate of infectious complications compared with CP and amikacin prophylaxis.
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Affiliation(s)
- Seong Hyeon Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
| | - Ji Won Ryu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Soo Kim
- Department of Urology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ho Seok Chung
- 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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11
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12
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Noweir HA, Modgil V, Pearce I. Male accessory gland inflammation (MAGI): an evolving entity. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/2051415820987687] [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
Male accessory gland infection (MAGI) is a generic acronym indicating inflammatory conditions affecting the prostate gland, seminal vesicles, the ductus deferens and the epididymis. It is a frequent disease, mostly with a chronic course. Majority of the MAGIs remain asymptomatic, thereby leading to a debate whether to treat these patients or not. The primary criterion for MAGI was suggested by Comhaire and colleagues in 1980. The role of MAGI in causing infertility and sexual dysfunctions has long been a matter of debate. The most recent studies show that MAGI could alter, with various mechanisms, both conventional and biofunctional sperm parameters, and determine worst reproductive outcome. This article provides an overview of up-to-date research findings about MAGI with special focus on data published on its impact on fertility; and diagnostic criteria including cellular and seminal biomarkers along with the promising results of emerging proteomic platforms for the identification of MAGI.
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Affiliation(s)
- Hosam A. Noweir
- Manchester Royal Infirmary, Manchester University Foundation Trust, UK
| | - Vaibhav Modgil
- Manchester Royal Infirmary, Manchester University Foundation Trust, UK
| | - Ian Pearce
- Manchester Royal Infirmary, Manchester University Foundation Trust, UK
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13
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Bjerklund Johansen TE, Kulchavenya E, Lentz GM, Livermore DM, Nickel JC, Zhanel G, Bonkat G. Fosfomycin Trometamol for the Prevention of Infectious Complications After Prostate Biopsy: A Consensus Statement by an International Multidisciplinary Group. Eur Urol Focus 2022; 8:1483-1492. [PMID: 34920977 DOI: 10.1016/j.euf.2021.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/19/2021] [Accepted: 11/26/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Transrectal ultrasound-guided prostate biopsy (TRPB) has been a standard of care for diagnosing prostate cancer but is associated with a high incidence of infectious complications. OBJECTIVE To achieve an expert consensus on whether fosfomycin trometamol provides adequate prophylaxis in TRPB and discuss its role as prophylaxis in transperineal prostate biopsy (TPPB). EVIDENCE ACQUISITION An international multidisciplinary group of experts convened remotely to discuss how to best use fosfomycin in various clinical settings and patient situations. Six statements related to prostate biopsy and the role of fosfomycin were developed, based on literature searches and relevant clinical experience. EVIDENCE SYNTHESIS Consensus was reached for all six statements. The group of experts was unanimous regarding fosfomycin as a preferred candidate for antimicrobial prophylaxis in TRPB. Fosfomycin potentially also meets the requirements for empiric prophylaxis in TPPB, although further clinical studies are needed to confirm or refute its utility in this setting. There is a risk of bias due to sponsorship by a pharmaceutical company. CONCLUSIONS Antimicrobial prophylaxis is mandatory in TRPB, and fosfomycin trometamol is an appropriate candidate due to low rates of resistance, a good safety profile, sufficient prostate concentrations, and demonstrated efficacy in reducing the risk of infectious complications following TRPB. PATIENT SUMMARY Patients undergoing transrectal ultrasound-guided prostate biopsy (TRPB) have a high risk of infectious complications, and antimicrobial prophylaxis is mandatory. However, increasing antimicrobial resistance, as well as safety concerns with fluoroquinolones, has restricted the number of antimicrobial options. Fosfomycin trometamol meets the requirements for a preferred antimicrobial in the prophylaxis of TRPB.
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Affiliation(s)
- Truls E Bjerklund Johansen
- Department of Urology, Oslo University Hospital, Nydalen, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark.
| | - Ekaterina Kulchavenya
- Urogenital Department, Novosibirsk Research TB Institute and Novosibirsk Medical University, Novosibirsk, Russian Federation
| | - Gretchen M Lentz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | | | - J Curtis Nickel
- Department of Urology, Queens University, Kingston, ON, Canada
| | - George Zhanel
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Gernot Bonkat
- Department of Urology, alta uro AG, Basel, Switzerland
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14
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Vandewalle T, Vander Eeckt K, Deconinck S, Weyne E, Verpoort P, Ost D. E. coli
bacterial meningitis after transrectal prostate biopsy under antibiotic prophylaxis: a case report and literature review. Clin Case Rep 2022; 10:e05921. [PMID: 35664519 PMCID: PMC9136698 DOI: 10.1002/ccr3.5921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/14/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022] Open
Abstract
Prostate biopsy, a frequently performed procedure, is not harmless. In rare cases, life‐threatening complications occur. We document a potential lethal bacterial meningitis after transrectal biopsy. In addition to our overview of all previously documented cases, we highlight the evidence of prevention of infectious complications when performing a prostate biopsy. Even after antibiotic prophylaxis, severe infections sometimes follow transrectal prostate biopsy. Involvement of the central nervous system is not well known but demands early recognition. In this situation, intravenous antibiotics with a high penetration through the blood–brain barrier are of vital importance. The most effective preventive measure against infectious complications is to change the biopsy approach to transperineal.
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Affiliation(s)
| | | | | | | | | | - Dieter Ost
- AZ Sint Blasius Dendermonde Belgium Hasselt
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15
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Comparison of Fluoroquinolones and Other Antibiotic Prophylaxis Regimens for Preventing Complications in Patients Undergoing Transrectal Prostate Biopsy. Antibiotics (Basel) 2022; 11:antibiotics11030415. [PMID: 35326878 PMCID: PMC8944856 DOI: 10.3390/antibiotics11030415] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 01/26/2023] Open
Abstract
Our study aimed to compare the incidence of infective complications after transrectal ultrasound-guided prostate biopsy (TRUSBx) when adopting different antimicrobial prophylaxis regimens. A multi-institutional cohort of 1150 patients who underwent TRUSBx was retrospectively analyzed. Procedures were performed between 2017 and 2019 (before and after the EMA warning about the use of fluoroquinolones for the antibiotic prophylaxis of patient candidates to TRUSBx). The primary endpoint was the occurrence of infective complications, including sepsis and/or fever. The population was stratified according to the antibiotic prophylaxis adopted: fluoroquinolones (levofloxacin, ciprofloxacin, prulifloxacin), cephalosporins (cefixime, ceftriaxone) or trimethoprim/sulfamethoxazole. Univariable and multivariable binomial logistic regression models were used to assess the odds ratio (OR) with 95% confidence interval (CI) testing of the risk of infective complication after adjusting for each prebiopsy covariate. In total, 478 (41.6%) patients received fluoroquinolone-based prophylaxis. Among these, 443 (38.5%), 25 (2.2%) and 10 (0.9%) patients received levofloxacin prophylaxis, ciprofloxacin and prulifloxacin, respectively while 14.6% received cefixime, 20.7% received the comedication of ceftriaxone/fosfomycin and 23.1% received trimethoprim/sulfamethoxazole. The trimethoprim/sulfamethoxazole and fluoroquinolone regimens were significantly associated with a lower risk of infective complications (OR 0.15, 95% CI 0.03−0.48, p = 0.003 and OR 0.17, 95% CI 0.06−0.43, p < 0.001, respectively). The ceftriaxone/fosfomycin (OR 0.21, 95% CI 0.04−0.92, p = 0.04) and fluoroquinolone (OR 0.07, 95% CI 0.00−0.70, p = 0.048) prophylaxis were associated with a lower risk of infective sequelae. Fluoroquinolone-based prophylaxis was associated with a lower risk of infective complications after TRUSBx compared to other prophylaxis regimens although its clinical application was recently forbidden by European Medical Agency restrictions.
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16
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Lim DG, Jung SI, Kim MS, Chung HS, Hwang EC, Kwon DD. Comparison of a combined regimen of fosfomycin and ciprofloxacin with ciprofloxacin alone as antimicrobial prophylaxis for transrectal prostate biopsy in the era of high fluoroquinolone-resistant rectal flora. Prostate Int 2021; 9:163-168. [PMID: 34692590 PMCID: PMC8498702 DOI: 10.1016/j.prnil.2021.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background To assess the prophylactic effect of fosfomycin (FM) and ciprofloxacin combinations for infectious complications of transrectal ultrasound-guided prostate biopsy (TRUSPB) compared to that of ciprofloxacin alone. Methods In total, 1,578 patients were enrolled and were divided into two groups according to the prophylactic antibiotics. Group 1 (n = 1234) received ciprofloxacin on the day of the biopsy and for an additional 1–2 days, whereas Group 2 (n = 334) was given FM in addition to ciprofloxacin in the same manner as Group 1. The primary outcome was overall infectious complications within 1 month of TRUSPB. The secondary outcome was the risk factors of infectious complications after TRUSPB. Results Infectious complications occurred in 31 patients (2.5%) and 1 patient (0.3%) in Groups 1 and 2, respectively. Our results indicated that fluoroquinolone (FQ) and FM significantly reduced the risk of infectious complications compared to FQ (relative risk: 0.12; 95% confidence interval 0.02–0.87, P = 0.015). Based on the multivariate analysis, previous antibiotic exposure (odds ratio [OR] = 3.59, P = 0.026), and the addition of FM (OR = 0.12, P = 0.038) were associated with infectious complications. Based on the rectal swab, FQ resistance was 28.0% (n = 294) in total. FQ resistance in the FQ and FM group was higher than that in the FQ group (n = 178, 54.9% vs. n = 116, 16.0%, P < 0.001). Conclusion The combination of ciprofloxacin and FM exhibited reduced infectious complications after TRUSPB compared with ciprofloxacin monotherapy and may be applicable in the era of the high abundance of FQ-resistant rectal flora.
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Affiliation(s)
- Do Gyeong Lim
- Department of Urology, Chonnam National University Medical School, Gwangju, 501-757, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, 501-757, Korea
| | - Myung Soo Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, 501-757, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, 501-757, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, 501-757, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, 501-757, Korea
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17
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Wagenlehner F, Bonkat G, Pilatz A. [Prostate biopsy 2021: current management]. Aktuelle Urol 2021; 52:356-359. [PMID: 33979884 DOI: 10.1055/a-1478-2793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Infectious complications following prostate biopsy are on the rise due to an increase in antimicrobial resistance, mainly against fluoroquinolones. The use of fluoroquinolones for perioperative prophylaxis is no longer approved by the national authorities in Germany. The EAU guideline group on urological infections has recently published a meta-analysis in two parts based on randomised controlled trials (RCTs). Transperineal prostate biopsy is associated with a significantly reduced rate of infectious complications compared with transrectal biopsy and should therefore be preferred. If transrectal biopsy is performed, intrarectal cleaning with povidone-iodine and antibiotic prophylaxis without fluoroquinolones should be chosen. Antibiotic prophylactic strategies include targeted prophylaxis after susceptibility testing of the rectal flora, augmented prophylaxis with multiple antibiotics and empiric mono-prophylaxis with non-fluoroquinolones. Data from RCTs are available for aminoglycosides, third-generation cephalosporins and fosfomycin trometamol.
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Affiliation(s)
- Florian Wagenlehner
- Justus-Liebig-Universität Gießen, Klinik für Urologie, Kinderurologie und Andrologie, Giessen
| | | | - Adrian Pilatz
- Justus-Liebig-Universität Gießen, Klinik für Urologie, Kinderurologie und Andrologie, Giessen
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18
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Kranz J, Schneidewind L, Pilatz A, Wagenlehner FRA. [Antibiotic prophylaxis for endourological interventions considering antibiotic stewardship]. Urologe A 2021; 60:383-392. [PMID: 33560463 DOI: 10.1007/s00120-021-01455-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
Perioperative antibiotic prophylaxis in endourology is used to reduce or avoid postoperative surgical site infections and complicated urinary tract infections. Special attention is paid to antibiotic stewardship strategies to avoid the continuing selection of antibiotics and multidrug-resistant uropathogens as well as collateral damage to the microbiome. The individual risk profile, the local resistance situation, the expected pathogen spectrum, the pharmacokinetics and the approval of each substance are important aspects to be considered in the indications and selection of perioperative antibiotic prophylaxis. Furthermore, applicable hygiene regulations and the surgical care of an intervention must be observed.
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Affiliation(s)
- Jennifer Kranz
- Klinik für Urologie und Kinderurologie, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland.
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
| | - Laila Schneidewind
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Adrian Pilatz
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Flo Ri An Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH, Justus-Liebig-Universität Gießen, Gießen, Deutschland
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19
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Pilatz A, Veeratterapillay R, Dimitropoulos K, Omar MI, Pradere B, Yuan Y, Cai T, Mezei T, Devlies W, Bruyère F, Bartoletti R, Köves B, Geerlings S, Schubert S, Grummet J, Mottet N, Wagenlehner F, Bonkat G. European Association of Urology Position Paper on the Prevention of Infectious Complications Following Prostate Biopsy. Eur Urol 2020; 79:11-15. [PMID: 33172721 DOI: 10.1016/j.eururo.2020.10.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
The transperineal approach is preferred to reduce prostate biopsy (PB)-related infections. Fluoroquinolones are suspended for prophylaxis of PB in the European Union; therefore, alternative antibiotics based on local resistance, or targeted prophylaxis, in conjunction with povidone-iodine rectal preparation are recommended for transrectal PB.
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Affiliation(s)
- Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany.
| | | | | | | | - Benjamin Pradere
- Department of Urology, CHRU Bretonneau, Tours, France; Université Francois Rabelais, PRES Centre Val de Loire, Tours, France
| | - Yuhong Yuan
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada
| | - Tommaso Cai
- Department of Urology, Santa Chiara, Reg. Hospital, Trento, Italy
| | - Tunde Mezei
- Department of Urology, Telemark Hospital, Skien, Norway
| | - Wout Devlies
- Department of Urology, UZ Leuven, Leuven, Belgium
| | - Franck Bruyère
- Department of Urology, CHRU Bretonneau, Tours, France; Université Francois Rabelais, PRES Centre Val de Loire, Tours, France
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, Italy
| | - Bela Köves
- Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary
| | - Suzanne Geerlings
- Department of Internal Medicine, Amsterdam University Medical Center, The Netherlands
| | - Sören Schubert
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Germany
| | - Jeremy Grummet
- Department of Surgery, Alfred Health, Central Clinical School, Monash University, Melbourne, Australia
| | - Nicolas Mottet
- Department of Urology, University Jean Monnet St Etienne, Saint-Étienne, France
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Gernot Bonkat
- Alta Uro AG, Merian Iselin Klinik, Center of Biomechanics and Calorimetry, University Basel, Basel, Switzerland
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20
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Pilatz A, Bonkat G, Wagenlehner F. [Infectious complications following prostate biopsy-Major changes 2020]. Urologe A 2020; 59:1486-1491. [PMID: 33044635 DOI: 10.1007/s00120-020-01365-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been suspended in Germany by the national authorities. OBJECTIVES This review is intended to highlight current strategies for reducing infectious complications following prostate biopsy. MATERIALS AND METHODS The European Association of Urology (EAU) guideline group on urological infections recently published a meta-analysis in two parts based on randomized controlled trials (RCTs). The most important contents shall be presented here. RESULTS Transperineal prostate biopsy is associated with significantly reduced infectious complications than transrectal biopsy. If transrectal biopsy is performed, intrarectal cleaning with povidone-iodine and antibiotic prophylaxis without fluoroquinolones should be chosen. Antibiotic prophylactic strategies include targeted prophylaxis after susceptibility testing of the rectal flora, augmented prophylaxis with multiple antibiotics and empiric monoprophylaxis with nonfluoroquinolones. Here data from RCTs are available for aminoglycosides, third generation cephalosporines, and fosfomycin trometamol. CONCLUSIONS The transperineal approach is preferred to reduce prostate biopsy-related infections. Fluoroquinolones are no longer approved for prophylaxis. Thus, alternative antibiotics based on local resistance, or targeted prophylaxis, in conjunction with povidone-iodine rectal preparation are recommended for transrectal prostate biopsy.
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Affiliation(s)
- A Pilatz
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
| | | | - F Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
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21
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Transrectal versus transperineal prostate biopsy under intravenous anaesthesia: a clinical, microbiological and cost analysis of 2048 cases over 11 years at a tertiary institution. Prostate Cancer Prostatic Dis 2020; 24:169-176. [PMID: 32759972 DOI: 10.1038/s41391-020-0263-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/10/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transrectal (TR) and transperineal (TP) approaches for prostate biopsy have different morbidity profiles. Our institution transitioned to a preference for multiparametric MRI-based triage and TP biopsy since 2014. The aim of this study was to compare clinical, microbiological and health economic outcomes between TR and TP prostate biopsy. METHODS A consecutive cohort study considered prostate biopsies over an 11 year period. Hospital presentations across the region within 30 days of biopsy were analysed for details and subsequent outcomes according to biopsy approach. Cost for each encounter (routine and unplanned) were analysed and generalised linear models applied, as well as cost implications for inclusion of mpMRI-based triage and TP biopsy preference. RESULTS In total, 2048 prostate biopsies were performed. Similar re-presentation rates per occurred for each biopsy approach (90 patients, TR 4.8%, TP 3.8%, p = 0.29), with 23 patients presenting more than once (119 total presentations). Presentations after TR biopsy were more likely to be of infectious aetiology (TR 2.92%, TP 0.26% de novo, p < 0.001) and result in hospital admission (TR 43/49, 93.4%; TP 14/24, 58.3%; p = 0.007) for similar rates of urinary retention (TR 2.76% vs TP 3.63%, p = 1). The mean overall cost (biopsy and re-presentations) was higher for the TP group (p < 0.001), adjusted for year and age, but reduced over time and was similar for patients who re-presented (p = 0.98). Incorporation of mpMRI (with subsequently avoided biopsies), TP biopsy and re-presentations resulted in AU$783.27 saving per biopsy. CONCLUSIONS TR biopsy resulted in more infectious complications and hospital admissions than TP biopsy for similar rates of re-presentation and urinary retention. TP biopsy costs reduced over time and use in conjunction with mpMRI provides an overall cost saving. Routine TP biopsy is safe and feasible, with further cost savings expected with other approaches (local anaesthetic) under investigation.
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22
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Di Bella S, Beović B, Fabbiani M, Valentini M, Luzzati R. Antimicrobial Stewardship: From Bedside to Theory. Thirteen Examples of Old and More Recent Strategies from Everyday Clinical Practice. Antibiotics (Basel) 2020; 9:antibiotics9070398. [PMID: 32664288 PMCID: PMC7399849 DOI: 10.3390/antibiotics9070398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/29/2022] Open
Abstract
“Antimicrobial stewardship” is a strategy that promotes the responsible use of antimicrobials. The objective of this paper is to focus on consolidated and more recent improvements in clinical strategies that should be adopted in hospitalized patients to ameliorate their infectious diseases’ outcome and to reduce the antibiotic resistance risk through judicious use of antibiotics. We present 13 common clinical scenarios, the respective suggested interventions and the explanations of the supporting evidence, in order to help clinicians in their decision-making process. Strategies including the choice of antibiotic and dose optimization, antibiotic spectrum narrowing (de-escalation), shortening of duration, shift to oral route or outpatient parenteral antibiotic (including elastomeric pumps), and biomarkers are described and discussed.
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Affiliation(s)
- Stefano Di Bella
- Department of Medical, Surgical and Health Sciences, Trieste University, 34127 Trieste, Italy;
- Correspondence:
| | - Bojana Beović
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Massimiliano Fabbiani
- Infectious Disease Unit, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy;
| | - Michael Valentini
- Azienda Sanitaria Universitaria Giuliano Isontina, 34128 Trieste, Italy;
| | - Roberto Luzzati
- Department of Medical, Surgical and Health Sciences, Trieste University, 34127 Trieste, Italy;
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23
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Zhong W, Roberts MJ, Saad J, Thangasamy IA, Arianayagam R, Sathianathen NJ, Gendy R, Goolam A, Khadra M, Arianayagam M, Varol C, Ko R, Canagasingham B, Ferguson R, Winter M. A Systematic Review and Meta-Analysis of Pelvic Drain Insertion After Robot-Assisted Radical Prostatectomy. J Endourol 2020; 34:401-408. [DOI: 10.1089/end.2019.0554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Wenjie Zhong
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Matthew J. Roberts
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Jeremy Saad
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Isaac A. Thangasamy
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Australia
| | | | | | - Rasha Gendy
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Ahmed Goolam
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Mohamed Khadra
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Mohan Arianayagam
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Celi Varol
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Raymond Ko
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | | | - Richard Ferguson
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Matthew Winter
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
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Morin A, Bergevin M, Rivest N, Lapointe SP. Antibiotic prophylaxis for transrectal ultrasound-guided prostate needle biopsy: Compared efficacy of ciprofloxacin vs. the ciprofloxacin/fosfomycin tromethamine combination. Can Urol Assoc J 2020; 14:267-272. [PMID: 32209218 DOI: 10.5489/cuaj.6248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Some authors advocate an increase in post-prostate needle biopsy (PNB) infections associated with emergent quinolone resistance in E. coli, urging re-evaluation of antibiotic prophylaxis (antibioprophylaxis). In this study, we compared rates of post-PNB urosepsis associated with two oral regimens of antibioprophylaxis: ciprofloxacin (CIP) vs. ciprofloxacin and fosfomycin tromethamine combination (CIP/FOS). METHODS This retrospective pre-/post-intervention study included all patients who underwent PNB in two Canadian hospitals from January 2012 to December 2015. The primary outcome was urosepsis within one month of PNB. Urosepsis rates were analyzed according to antibioprophylaxis using log-binomial regression, considering the propensity score weights of collected risk factor data. RESULTS We reviewed 2287 PNB patients. A total of 1090 received CIP and 1197 received CIP/FOS. Urosepsis incidence with CIP was 1.1% (12/1090) and fell to 0.2% (2/1197) with CIP/FOS. Our analysis indicates that CIP/FOS significantly decreased the risk of urosepsis compared to CIP alone (adjusted relative risk [aRR] 0.16; p=0.021). The isolated pathogen was E. coli in 12/14 cases, including seven bacteremias. Among E. coli cases, seven strains were CIP-resistant. Eleven of 12 E. coli, including all CIP-resistant strains, were isolated in patients on CIP alone. One case of B. fragilis bacteremia occurred in the CIP/FOS group. No cases of C. difficile were identified in the three months post-PNB. CONCLUSIONS The adoption of CIP/FOS antibiotic prophylaxis significantly lowered the rate of post-PNB urosepsis. Conveniently, this regimen is oral, single-dose, and low-cost.
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Affiliation(s)
- Alexandre Morin
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marco Bergevin
- Department of Microbiology, Cité-de-la-Santé Hospital, Laval, affiliated with Université de Montréal, Montreal, QC, Canada
| | - Natalie Rivest
- Department of Microbiology, Cité-de-la-Santé Hospital, Laval, affiliated with Université de Montréal, Montreal, QC, Canada
| | - Steven P Lapointe
- Urology Service UroLaval, Cité-de-la-Santé Hospital, Laval and St-Eustache Hospital, affiliated with Université de Montréal, Montreal, QC, Canada
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25
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Infectious complications of prostate biopsy: winning battles but not war. World J Urol 2020; 38:2743-2753. [PMID: 32095882 DOI: 10.1007/s00345-020-03112-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/30/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prostate biopsy is a standard tool for diagnosing prostate cancer, with more than 4 million procedures performed worldwide each year. Infectious complications and economic burden are reportedly rising with continued use of trans-rectal ultrasound-guided biopsy, despite the transperineal approach being associated with less infectious complications. OBJECTIVE AND METHODS In this review, the contemporary literature on pathophysiology, epidemiology, risk factors, causative organisms and emerging approaches for prevention of infectious complications are outlined. RESULTS Management of infectious complications after TRUSB has caused significant financial burden on health systems. The most frequent causative agents of infectious complications after prostate biopsy are Gram-negative bacilli are particularly concerning in the era of antibiotic resistance. Increasing resistance to fluoroquinolones and beta-lactam antibiotics has complicated traditional preventive measures. Patient- and procedure-related risk factors, reported by individual studies, can contribute to infectious complications after prostate biopsy. CONCLUSIONS Recent literature shows that the transrectal ultrasound-guided prostate biopsy results in higher infectious complication rate than the transperineal prostate biopsy. NAATs, recently introduced technique to detect FQr may detect all antibiotic-resistant rectal microbiota members-included MDRs-although the technique still has limitations and economical burdens. Transient solutions are escalating antibiotic prophylaxis and widening the indications for TPB.
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26
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Demirtaş A, Eren E, Sönmez G, Tombul ŞT, Alp E. Turkish Urologists' preferences regarding antibiotic prophylaxis for transrectal prostate biopsy. Turk J Urol 2019; 46:213-218. [PMID: 32401705 DOI: 10.5152/tud.2019.19051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Antibiotic prophylaxis for transrectal prostate biopsy (PB) is very important in preventing infectious complications, and in this study, we aimed to evaluate the antibiotic preferences of Turkish urologist for transrectal PB. MATERIAL AND METHODS The survey about PB and antibiotic prophylaxis behaviors was administered to urologists working in Turkey who had previously participated in at least one international and one national congress. RESULTS A total of 237 urologists were included in the study. Antibiotic prophylaxis prior to PB was performed by 234 (98.7%) participants. Rectal swabbing prior to PB was not performed by 227 (95.8%) participants. The most common complication associated with PB was prostatitis (63%), followed by urinary tract infection (29%). Only 25.7% of Turkish urologists reported a single dose of antibiotic prophylaxis. Our participants often administered antibiotic prophylaxis for a period of 3, 5, or 7 days (16%, 21.1%, 35.9%, respectively). The most common antibiotic agent preferred for prophylaxis was ciprofloxacin (65%). CONCLUSION The biopsy behavior of Turkish urologists was mostly compatible with the literature, but it was revealed that Turkish urologists do not prefer single-dose antibiotic therapy, and their practice patterns regarding the administration of pre-biopsy rectal swabbing are inconsistent with the literature.
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Affiliation(s)
- Abdullah Demirtaş
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Esma Eren
- Department of Infectious Diseases and Clinical Microbiology, Kayseri City Hospital, Kayseri, Turkey
| | - Gökhan Sönmez
- Department of Urology, Kayseri City Hospital, Kayseri, Turkey
| | - Şevket Tolga Tombul
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University School of Medicine, Kayseri, Turkey
| | -
- Turkish Urology Academy, Study Group of Prostate Biopsy: Ateş Kadıoğlu, Asıf Yıldırım, Sakıp Erturhan, Akif Erbin
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27
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[Importance of magnetic resonance imaging/ultrasound-guided fusion biopsy for the detection and monitoring of prostate cancer]. Urologe A 2019; 58:1499-1510. [PMID: 31741003 DOI: 10.1007/s00120-019-01069-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The use of multiparametric magnetic resonance imaging (mpMRI) is becoming increasingly more important for the primary diagnostics of prostate cancer (PCa) and for monitoring under active surveillance. Current studies confirmed that the use of mpMRI can increase the detection of clinically significant PCa and reduce the detection rate of insignificant PCa as well as the rate of unnecessary biopsies. The information from mpMRI can be cognitively used for in-bore biopsy and using fusion biopsy systems. There are no clear recommendations on the access approach for fusion biopsy (e. g. transrectal or perineal), whereby higher rates of rectal bleeding and infections have been described for transrectal access compared to perineal access. The increasing rate of antibiotic resistance as well as restricted indications for the use of quinolones are a major challenge for transrectal biopsy.
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28
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Time to Adapt Our Practice? The European Commission Has Restricted the Use of Fluoroquinolones since March 2019. Eur Urol 2019; 76:273-275. [DOI: 10.1016/j.eururo.2019.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/12/2019] [Indexed: 11/17/2022]
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29
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Avent ML, Rogers BA, Cheng AC, Athan E, Francis JR, Roberts MJ, Paterson DL, Harris PNA. Fosfomycin: what was old is new again. Intern Med J 2019; 48:1425-1429. [PMID: 30517987 DOI: 10.1111/imj.14122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Minyon L Avent
- Infection and Immunity Theme, UQ Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.,Queensland Statewide Antimicrobial Stewardship Program, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Benjamin A Rogers
- Department of Epidemiology and Preventive Medicine, Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Monash Health, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Geelong, Victoria, Australia.,Geelong Centre for Emerging Infectious Disease, School of Medicine, Deakin University, Melbourne, Victoria, Australia
| | - Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Matthew J Roberts
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - David L Paterson
- Infection and Immunity Theme, UQ Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Patrick N A Harris
- Infection and Immunity Theme, UQ Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Pathology Queensland, Central Laboratory, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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30
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Sadahira T, Wada K, Nasu Y. Editorial Comment from Dr Sadahira et al. to Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study. Int J Urol 2019; 26:399. [PMID: 30659661 DOI: 10.1111/iju.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koichiro Wada
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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31
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Macdonald A, Roberts MJ. Editorial Comment from Dr Macdonald and Dr Roberts to Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study. Int J Urol 2019; 26:397-398. [PMID: 30644140 DOI: 10.1111/iju.13895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Alastair Macdonald
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Matthew J Roberts
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
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32
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Van Besien J, Uvin P, Weyne E, Van Praet C, Merckx L, De Graeve N, Van Renterghem K, Cartuyvels R, Van den Abeele A. Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study. Int J Urol 2018; 26:391-397. [DOI: 10.1111/iju.13883] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Pieter Uvin
- Department of Urology AZ Sint‐Lucas Hospital Ghent Belgium
| | - Emmanuel Weyne
- Department of Urology AZ Sint‐Lucas Hospital Ghent Belgium
| | | | - Luc Merckx
- Department of Urology AZ Sint‐Lucas Hospital Ghent Belgium
| | - Nico De Graeve
- Department of Urology AZ Sint‐Lucas Hospital Ghent Belgium
| | - Koenraad Van Renterghem
- Department of Urology Jessa Hospital Hasselt Belgium
- Department of Urology Sint Franciscus Hospital Heusden‐Zolder Belgium
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33
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Sukumaran V, Roberts MJ, Harris PNA. Infectious complications following transrectal ultrasound-guided prostate biopsy: what additional diagnostic value do blood cultures provide? Infect Dis (Lond) 2018; 50:804-806. [PMID: 30317904 DOI: 10.1080/23744235.2018.1508886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Vichitra Sukumaran
- a Pathology Queensland, Department of Microbiology , Central Laboratory, Royal Brisbane & Women's Hospital , Herston , QLD , Australia
| | - Matthew J Roberts
- b UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Faculty of Medicine , University of Queensland , Herston , QLD , Australia.,c Department of Urology , Royal Brisbane and Women's Hospital , Brisbane , QLD , Australia
| | - Patrick N A Harris
- d Infection Management Services, Princess Alexandra Hospital , Brisbane , QLD , Australia
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34
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Seo YE, Ryu H, Oh JJ, Jeong SJ, Hwang SI, Lee HJ, Hong SK, Byun SS, Lee SE, Lee S. Clinical Importance of Antibiotic Regimen in Transrectal Ultrasound-Guided Prostate Biopsy: A Single Center Analysis of Nine Thousand Four Hundred Eighty-Seven Cases. Surg Infect (Larchmt) 2018; 19:704-710. [PMID: 30227106 DOI: 10.1089/sur.2018.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of an antibiotic regimen for prostate biopsy by analyzing patients who were hospitalized because of complications after transrectal ultrasound-guided prostate biopsy. METHODS We reviewed retrospectively the medical records of 10,339 patients who underwent transrectal ultrasound-guided prostate biopsy at our institution from May 2003 to April 2017. We excluded patients with low quality data. All patients underwent urine culture before transrectal ultrasound-guided prostate biopsy and received intravenous antibiotic agents 30-60 minutes before biopsy. Patients were either given prophylactic quinolone or cephalosporin (second or third generation). Clinicopathologic factors including patient age, antibiotic regimen, number of biopsy cores, body mass index, prostate specific antigen, prostate volume, and infection-related complications that required hospitalization were subsequently analyzed. RESULTS A total of 9,487 patients were included in the final analysis, of whom 33 patients (0.35%) were hospitalized because of infection-related complications. Infection-related hospitalization rates were lower in patients who received cephalosporin (0.2%) than in patients who received quinolone (1.59%). At our institution, cephalosporin has been used predominantly to prevent post-biopsy infections since February 2013. Only five patients (0.12%) developed infection-related complications of the 3,863 patient who underwent transrectal ultrasound-guided prostate biopsy since February 2013. Multivariable analysis revealed that use of second- or third-generation cephalosporin was the only independent predictor of infection-related complications. CONCLUSION Implementing an effective antibiotic prophylaxis regimen at our institution by using second- or third-generation cephalosporin could reduce infection-related complications after transrectal ultrasound-guided prostate biopsy.
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Affiliation(s)
- Young Eun Seo
- 1 Department of Urology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Hoyoung Ryu
- 1 Department of Urology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Jong Jin Oh
- 1 Department of Urology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Seong Jin Jeong
- 1 Department of Urology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Sung Il Hwang
- 2 Department of Radiology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Hak Jong Lee
- 2 Department of Radiology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Sung Kyu Hong
- 1 Department of Urology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Seok-Soo Byun
- 1 Department of Urology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Sang Eun Lee
- 1 Department of Urology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Sangchul Lee
- 1 Department of Urology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
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35
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Cimino S, Verze P, Venturino L, Alessio P, Migliara A, Imbimbo C, Mirone V, Russo GI, Morgia G. Complication Rate After Antibiotic Prophylaxis with Fosfomycin Versus Fluorochinolones or β-lactam Antibiotics in Patients Undergoing Prostate Biopsy: A Propensity Score-adjusted Analysis. Eur Urol Focus 2018; 6:370-375. [PMID: 30007542 DOI: 10.1016/j.euf.2018.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/18/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Transrectal ultrasound-guided prostate biopsy (TRBx) or transperineal Bx (TPBx) are considered alternative approaches for the diagnosis of prostate cancer (PCa). However, urinary tract infection (UTI) or other complications could be more frequent in the TRBx approach. OBJECTIVE To determine the complication rate following different antimicrobial prophylaxis (AMP; fosfomycin trometamol [FT] vs ß-lactame or fluorochinolones [FQ]) in patients undergoing TRBx or TPBx. DESIGN, SETTING, AND PARTICIPANTS The analyses were based on prospectively collected data of a cohort of patients who underwent TRBx or TPBx for elevated prostate-specific antigen (PSA; ≥4ng/ml) or clinical suspicion of PCa, between September 2016 and March 2017. Patients received a single dose of 3g oral FT (group A) or, alternatively, FQ or ß-lactame (group B). INTERVENTION TRBx versus TPBx. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Adjustment variables consisted of age, PSA, biopsy technique (TPBx vs TRBx), and antibiotic prophylaxis (FT vs ß-lactame or FQ) using 1:1 propensity-score matching. Overall, 526 patients were considered, of whom 258 received FT (group A) and the other 258 received ß-lactame or FQ (group B). RESULTS AND LIMITATIONS Overall complications occurred in 390 (75.58%) and major complications in 67/516 (12.98%). Lower prevalence of UTIs was detected in group A (34.1%) compared with that in group B (43.4%; p=0.03), while similar rates of haematuria (54.7% vs 55.4%), haemospermia (39.5% vs 33.0%), and acute urinary retention (11.6% vs 9.3%) were detected in groups A and B. We found that group B (odds ratio [OR]: 1.54; p=0.03), I grade haematuria (OR: 6.17; p<0.01), and II grade haematuria (OR: 5.13; p<0.01) were significantly associated with increased risk of UTIs. CONCLUSIONS AMP with fluoroquinoles or ß-lactam antibiotics increased the rate of UTIs, when compared with FT, in patients undergoing TRBx or TPBx. The appearance of haematuria or haemospermia is associated with UTIs, suggesting the possibility of tailoring the strategy for prophylaxis in this category of patients. PATIENT SUMMARY In this study, comparing complications after transrectal ultrasound-guided prostate biopsy versus transperineal biopsy, prophylaxis with fluoroquinoles or ß-lactam antibiotics increased the rate of urinary tract infections when compared with fosfomycin trometamol, regardless of the type of biopsy approach.
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Affiliation(s)
- Sebastiano Cimino
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Paolo Verze
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luca Venturino
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Paolo Alessio
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Alfonso Migliara
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ciro Imbimbo
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Vincenzo Mirone
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giorgio Ivan Russo
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Giuseppe Morgia
- Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
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36
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Scott S, Harris PN, Williamson DA, Liss MA, Doi SAR, Roberts MJ. The effectiveness of targeted relative to empiric prophylaxis on infectious complications after transrectal ultrasound-guided prostate biopsy: a meta-analysis. World J Urol 2018; 36:1007-1017. [PMID: 29453690 DOI: 10.1007/s00345-018-2217-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/31/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Rectal culture screening for fluoroquinolone (FQ)-resistant Enterobacteriaceae before transrectal ultrasound guided prostate (TRUSPB) biopsy and targeted antibiotic prophylaxis (TAP) may decrease post-TRUSPB infection rates compared to empiric (EAP) regimens. The objective of this study was to evaluate the effectiveness of targeted relative to empiric prophylaxis regimens on rates of infectious complications after TRUSPB and to determine the baseline prevalence of FQ resistance based on prior rectal swabs. METHODS An electronic search within literature databases including EMBASE and Web of Science (all databases) for articles assessing TAP as an approach to TRUSPB prophylaxis was conducted. Quality assessment was performed using the Hoy instrument. Meta-analysis was performed using MetaXL 5.3. RESULTS From 15 studies (eight retrospective and seven prospective) representing 12,320 participants, infectious complication incidence was 3.4% in EAP and 0.8% in TAP patients. The number needed to treat with TAP to avoid one more infection when compared to the EAP group was 39. Effect sizes were homogeneous. Prevalence of FQ resistance showed low (15%) and high (28%) subgroups, likely due to region of origin (within and outside USA, respectively). CONCLUSIONS Rectal culture prior to TRUSPB and use of TAP adjusts for endemic FQ resistance and is associated with less infectious complications and resulting morbidity when compared to EAP. Overtreatment associated with augmented prophylaxis approaches may be reduced as a result. Further prospective assessment and cost-benefit analyses are required before widespread implementation can be recommended.
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Affiliation(s)
- Susan Scott
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Patrick N Harris
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- The University of Queensland, Centre for Clinical Research, Brisbane, QLD, Australia
- Central Laboratory, Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Michael A Liss
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
| | - Matthew J Roberts
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
- The University of Queensland, Centre for Clinical Research, Brisbane, QLD, Australia.
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