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Krsakova E, Cermak A, Fedorko M. Comparison of different regimens of short-term antibiotic prophylaxis in transrectal prostate biopsy. J Hosp Infect 2024; 145:83-87. [PMID: 38219833 DOI: 10.1016/j.jhin.2023.12.012] [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: 11/07/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Prostate cancer is the most common malignant solid tumour in men aged >70 years and is the second most common cause of death from oncological circumstances. AIM To evaluate the effect of different short-term prophylactic antibiotic regimens in transrectal prostate biopsy (PB) on the incidence of infectious complications. METHODS Patients who underwent transrectal ultrasound-guided PB between January 2021 and December 2022 were included in the prospective randomized study. According to the regimen of prophylaxis, patients were randomized into three groups: (1) fosfomycin trometamol 3 g, 3 h before the procedure + ciprofloxacin 500 mg, 2 h before the procedure; (2) fosfomycin trometamol 3 g, 3 h before and 24 h after the procedure; (3) ciprofloxacin 500 mg 12, 2 h before the procedure, and 12 h after the procedure. A rectal swab was performed 1-2 weeks before PB to evaluate the culture findings. Complications were evaluated during follow-up visits within one month after PB. FINDINGS In the monitored period, 605 PBs were performed, and 544 patients met the inclusion criteria (184, 161, and 199 in groups 1, 2, and 3). Infectious complications occurred in 10 cases (1.83%), namely 3, 4, and 3 according to patient groups. There was no statistically significant difference between the individual groups. None of the patients required hospitalization and all were free of symptoms of sepsis. CONCLUSION Short-term antibiotic prophylaxis in PB using fosfomycin trometamol, ciprofloxacin, or their combination appears to be effective. Fosfomycin trometamol is a suitable alternative to fluoroquinolone antibiotics.
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Affiliation(s)
- E Krsakova
- Department of Urology, University Hospital Brno, Brno, Czechia
| | - A Cermak
- Department of Urology, University Hospital Brno, Brno, Czechia; Faculty of Medicine, Masaryk University, Brno, Czechia
| | - M Fedorko
- Department of Urology, University Hospital Brno, Brno, Czechia; Faculty of Medicine, Masaryk University, Brno, Czechia.
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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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Lim DG, Jung SI, Hwang EC, Kim TH, Bae S, Huh JS, Lee SJ, Chung H, Choi H. Effectiveness of fosfomycin-based antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: A Korean multicenter study. Investig Clin Urol 2023; 64:289-295. [PMID: 37341009 DOI: 10.4111/icu.20220413] [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: 12/31/2022] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Recent studies have highlighted increasing infectious complications due to fluoroquinolone (FQ)-resistant organisms in men undergoing transrectal ultrasound-guided prostate biopsy (TRUSPB). This study investigated whether fosfomycin (FM)-based antibiotic prophylaxis reduces infections after TRUSPB and identified risk factors for infective complications. MATERIALS AND METHODS A multicenter study was conducted in the Republic of Korea from January 2018 to December 2021. Patients undergoing prostate biopsy with FQ or FM-based prophylaxis were included. The primary outcome was the post-biopsy infectious complication rate after FQ (group 1) or FM-based antibiotic prophylaxis with FM alone (group 2) or FQ and FM (group 3). Risk factors for infectious complications after TRUSPB were secondary outcomes. RESULTS Patients (n=2,595) undergoing prostate biopsy were divided into three groups according to the type of prophylactic antibiotics. Group 1 (n=417) received FQ before TRUSPB. Group 2 (n=795) received FM only and group 3 (n=1,383) received FM and FQ before TRUSPB. The overall post-biopsy infectious complication rate was 1.27%. The infectious complication rates were 2.4%, 1.9%, and 0.5% in groups 1, 2, and 3, respectively (p=0.002). In multivariable analysis, predictors of post-biopsy infectious complications included an association with health care utilization (adjusted odds ratio [OR], 4.66; 95% confidence interval [CI], 1.74-12.4; p=0.002) and combination antibiotic prophylaxis (FQ and FM) (adjusted OR, 0.26; 95% CI, 0.09-0.69; p=0.007). CONCLUSIONS In comparison with monotherapy with FM or FQ, combination antibiotic prophylaxis (FQ and FM) showed a lower rate of infectious complications after TRUSPB. Utilization of health care was an independent risk factor for infectious complications after TRUSPB.
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Affiliation(s)
- Do Gyeong Lim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Tae-Hyoung Kim
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| | - Sangrak Bae
- Department of Urology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jung-Sik Huh
- Department of Urology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Seung-Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hong Chung
- Department of Urology, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
| | - Hoon Choi
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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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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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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Delory T, Goujon A, Masson-Lecomte A, Arias P, Laurancon-Fretar A, Bercot B, Mongiat-Artus P, Molina JM, Lafaurie M. Fosfomycin-trometamol (FT) or fluoroquinolone (FQ) as single-dose prophylaxis for transrectal ultrasound-guided prostate biopsy (TRUS-PB): A prospective cohort study. Int J Infect Dis 2020; 102:269-274. [PMID: 33129963 DOI: 10.1016/j.ijid.2020.10.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The increasing incidence of fluoroquinolones (FQ) resistance may lower its efficacy in preventing UTI following transrectal ultrasound-guided prostate biopsy (TRUS-PB). We assessed the efficacy and safety of FQ and fosfomycin-trometamol (FT) in patients undergoing TRUS-PB. METHODS A prospective observational study was conducted between April 2017 and June 2019 and enrolled men undergoing TRUS-PB and receiving a single-dose of FQ (FQ-arm) or FT (FT-arm) for UTI prophylaxis per physician's choice. The primary efficacy endpoint was self-reported TRUS-PB UTI. We assessed baseline factors associated with UTI with logistic regression. RESULTS A total of 222 men were enrolled, 141/222 (64%) received FQ, and 81/222 (36%) FT. The median age was 67.6 years [IQR, 61.4-72.1] and the Charlson score was 3 [IQR, 3-5]. The overall incidence of self-reported TRUS-PB UTI was 12% (24/197, (95%CI, 8%-17%)): 15% (17/116, (95% CI, 10%-17%)) in FQ-arm, versus 9% (7/81, 95% CI (5%-13%)) in FT-arm (RR = 0.55 (95% CI, 0.22-1.40), p-value = 0.209). No baseline characteristic was significantly associated with TRUS-PB UTI. Safety was similar between the arms: the rate of the reported adverse event was 31% (36/116, (95% CI, 25%-37%) in the FQ-arm versus 36% (28/81, (95% CI, 28%-41%)) in the FT-arm (RR = 1.17 (95% CI, 0.64-2.15), p = 0.602). CONCLUSIONS TRUS-PB UTI prophylaxis with FT and FQ has similar efficacy and safety. A randomized comparison of these two antibiotics is warranted.
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Affiliation(s)
- Tristan Delory
- APHP, Infectious Diseases and Tropical medicine department, Saint-Louis Hospital, F-75010, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F75012, Paris, France.
| | - Annabelle Goujon
- APHP, Urology department, Saint-Louis Hospital, F-75010, Paris, France
| | - Alexandra Masson-Lecomte
- APHP, Urology department, Saint-Louis Hospital, F-75010, Paris, France; Université de Paris, France
| | - Pauline Arias
- APHP, Microbiology department, Saint-Louis Hospital, F-75010, Paris, France
| | - Anthony Laurancon-Fretar
- APHP, Infectious Diseases and Tropical medicine department, Saint-Louis Hospital, F-75010, Paris, France
| | - Béatrice Bercot
- APHP, Microbiology department, Saint-Louis Hospital, F-75010, Paris, France; Université de Paris, France
| | - Pierre Mongiat-Artus
- APHP, Urology department, Saint-Louis Hospital, F-75010, Paris, France; APHP, Microbiology department, Saint-Louis Hospital, F-75010, Paris, France; APHP, Pharmacy department, Saint-Louis Hospital, F-75010, Paris, France
| | - Jean-Michel Molina
- APHP, Infectious Diseases and Tropical medicine department, Saint-Louis Hospital, F-75010, Paris, France; Université de Paris, France
| | - Matthieu Lafaurie
- APHP, Infectious Diseases and Tropical medicine department, Saint-Louis Hospital, F-75010, Paris, France.
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Styrke J, Resare S, Lundström KJ, Masaba P, Lagerros C, Stattin P. Current routines for antibiotic prophylaxis prior to transrectal prostate biopsy: a national survey to all urology clinics in Sweden. F1000Res 2020; 9:58. [PMID: 32399200 PMCID: PMC7194489 DOI: 10.12688/f1000research.19260.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 02/05/2023] Open
Abstract
Background: The risk of infection after transrectal ultrasound (TRUS)-guided prostate biopsies is increasing. The aim of the study was to assess the use of antibiotic prophylaxis for prostate biopsy in Sweden. Methods: All public and private urology clinics reporting to the National Prostate Cancer Register of Sweden received a survey on TRUS-biopsy prophylaxis. Results: Of the 84 clinics surveyed, 76 replied (90%). If no risk factors for infection were present, a single dose of ciprofloxacin 750 mg was used by 50 clinics (66%). Multiple doses of ciprofloxacin 500 or 750 mg (n=14; 18%) or a single dose of trimethoprim-sulfamethoxazole 160/800 mg (n=7; 9%) were other common prophylaxes. Most clinics gave the prophylaxes immediately before the biopsy (n=41; 54%). Urine dipstick was used by 30 clinics (39%) and rectal enema by six (8%). In patients with high risk of infection, the survey mirrors a large variety of regiments used. Conclusions: The preference to use a single dose of ciprofloxacin 750 mg is in accordance with the Swedish national guidelines for patients with a low risk of infection. Better compliance to the guideline recommendation to use a urine dipstick would probably increase the number of patients classified as having an increased risk of infection. Being classified as a high-risk patient should lead to an extended duration of antibiotic prophylaxis, however, the variety of regimens used in the high-risk group reflects an inability to treat these patients in a standardized fashion and also highlights a need for more clear-cut guidelines. Pre-biopsy identification of high-risk patients is an important issue to tackle for the urologic clinics in order to reduce the number of infections.
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Affiliation(s)
- Johan Styrke
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, 901 87, Sweden
| | - Sven Resare
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, 901 87, Sweden
| | - Karl-Johan Lundström
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, 901 87, Sweden
| | - Patrick Masaba
- Department of Urology, Sundsvall Hospital, Sundsvall, 851 86, Sweden
| | - Christofer Lagerros
- Department of Surgical Sciences, Uppsala University, Uppsala, 752 36, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, 752 36, Sweden
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8
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Knaapila J, Gunell M, Syvänen K, Ettala O, Kähkönen E, Lamminen T, Seppänen M, Jambor I, Rannikko A, Riikonen J, Munukka E, Eerola E, Hakanen AJ, Boström PJ. Prevalence of Complications Leading to a Health Care Contact After Transrectal Prostate Biopsies: A Prospective, Controlled, Multicenter Study Based on a Selected Study Cohort. Eur Urol Focus 2019; 5:443-448. [DOI: 10.1016/j.euf.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/14/2017] [Accepted: 12/02/2017] [Indexed: 12/24/2022]
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Freitas DMDO, Moreira DM. Fosfomycin trometamol vs ciprofloxacin for antibiotic prophylaxis before transrectal ultrasonography-guided prostate biopsy: A meta-analysis of clinical studies. Arab J Urol 2019; 17:114-119. [PMID: 31285922 PMCID: PMC6600070 DOI: 10.1080/2090598x.2019.1592636] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives: To perform a systematic review and meta-analysis of clinical studies to assess the comparative prophylactic effectiveness of fosfomycin trometamol (FMT) vs ciprofloxacin (CIP) in men who underwent transrectal ultrasonography-guided prostate needle biopsy (TRUS-PNB), as infectious complications are a major concern after TRUS-PNB and although fluoroquinolones are currently the first choice, an increase in resistance has raised the question about its recommendation and FMT is a broad-spectrum oral antibiotic with low bacterial resistance. Methods: A systematic review was performed between January 1970 and June 2017 using the Web of Science, Scopus and PubMed databases to identify relevant studies. Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria were used for article selection. Outcomes of interest were febrile and afebrile urinary tract infections (UTIs) and the presence of fluoroquinolone-resisitant (FQR)- or extended-spectrum β-lactamase (ESBL)-producing uropathogens in urinary cultures. Results: Four studies including 2331 men were analysed; 1088 had FMT and 1243 CIP as antibiotic prophylaxis before TRUS-PNB. FMT prophylaxis resulted in significantly less afebrile (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.12–0.38; P < 0.001) and febrile (OR 0.15, 95% CI 0.07–0.31; P < 0.001) UTIs than CIP. Amongst all urine cultures, patients in the FMT arm also had a significantly lower prevalence of FQR and ESBL (E. coli or K. pneumoniae) microorganisms when compared to the CIP group (OR 0.25, 95% CI 0.12–0.21, P = 0.001; and OR 0.24, 95% CI 0.10–0.58, P = 0.001, respectively). Conclusions: Antibiotic prophylaxis with FMT before TRUS-PNB was associated with lower rates of infectious complications when compared to CIP. Abbreviations: CIP: ciprofloxacin; ESBL: extended-spectrum β-lactamase; FMT: fosfomycin trometamol; FQR: fluoroquinolone-resisitant; OR: odds ratio; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; TRUS-PNB: TRUS-guided prostate needle biopsy
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Affiliation(s)
| | - Daniel M Moreira
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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10
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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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11
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Effectiveness of fosfomycin tromethamine prophylaxis in preventing infection following transrectal ultrasound-guided prostate needle biopsy: Results from a large Canadian cohort. J Glob Antimicrob Resist 2018; 17:112-116. [PMID: 30553114 DOI: 10.1016/j.jgar.2018.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Rates of infection following transrectal ultrasound-guided prostate biopsy (TRUSPB) are increasing. The aim of this study was to evaluate the effectiveness of fosfomycin tromethamine (FMT) prophylaxis in preventing post-TRUSPB infectious complications. METHODS This nested case-control study included patients undergoing TRUSPB in a Canadian tertiary-care hospital who developed post-TRUSPB bacteraemia or urinary tract infection. Four prophylaxis periods were defined: (i) ciprofloxacin, low-resistance period (CIPRO-LOW), 2002-2009; (ii) ciprofloxacin, high-resistance period (CIPRO-HIGH), 2010-October 2013; (iii) oral FMT, one dose (FOSFO1), December 2013-September 2015; and (iv) oral FMT, two doses (FOSFO2), November 2015-June 2016. Incidence rates of the infection were calculated. RESULTS TRUSPB (n=9391) resulted in 138 cases of urinary sepsis (58% with bacteraemia). The incidence rates were 1.8% (CIPRO-HIGH), 3.5% (FOSFO1; P=0.004 vs. CIPRO-HIGH) and 2.7% (FOSFO2; P=0.19 vs. CIPRO-HIGH). Although Escherichia coli remained the predominant pathogen with fosfomycin-based regimens, the proportion of infections caused by Klebsiella spp. was higher (20/66; 30.3%) than with ciprofloxacin-based regimens (2/77; 2.6%; P<0.0001). CONCLUSION Independent risk factors for infection were the prophylactic regimen administered, presence of urological co-morbidities and diabetes. FMT was therefore not an effective alternative to ciprofloxacin for preventing post-TRUSPB urinary sepsis. These results highlight the need for novel antibacterial prophylaxis approaches.
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Pilatz A, Veeratterapillay R, Köves B, Cai T, Bartoletti R, Wagenlehner F, Bruyère F, Geerlings S, Bonkat G, Pradere B. Update on Strategies to Reduce Infectious Complications After Prostate Biopsy. Eur Urol Focus 2018; 5:20-28. [PMID: 30503175 DOI: 10.1016/j.euf.2018.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/04/2018] [Accepted: 11/19/2018] [Indexed: 11/24/2022]
Abstract
CONTEXT Prostate biopsy is one of the most performed procedures in urology. As a diagnostic procedure it should be of low risk. However, morbidity following prostate biopsy is common due to infectious complications. OBJECTIVE To describe how to reduce infectious complications following prostate biopsy. We report on antibiotic and technical interventions to reduce infectious complications. EVIDENCE ACQUISITION The data presented are based on a narrative review. Search in PubMed and Medline was performed until May 2018 with a focus on randomised controlled trials and meta-analyses. Articles were reviewed for data on symptomatic infections, hospitalisation, and adverse events. EVIDENCE SYNTHESIS Antibiotic prophylaxis is the standard of care. However, the duration of antibiotic preemptive treatment is still under debate. The use of augmented antibiotic prophylaxis as well as targeted antibiotic prophylaxis might be of potential value, but evidence is currently limited. Moreover, no antibiotic class was shown to be clearly superior to another. The evaluation of the technical aspects during prostate biopsy reveals that rectal preparation with povidone-iodine is clearly effective to reduce infectious complications. Transperineal biopsy has a potential benefit to reduce infectious complications, but powerful randomised controlled studies are missing. Finally, the number of biopsy cores, the application of periprostatic nerve block, or the use of a cleansing enema has no impact on prostate biopsy in terms of infectious complications. CONCLUSIONS The available data only suggest that rectal preparation with povidone-iodine as well as antibiotic prophylaxis is of significant advantage to reduce infectious complications following prostate biopsy. The augmented and targeted antibiotic prophylaxis shows some potential, but need further validation. PATIENT SUMMARY In this review we evaluate the best management strategy to prevent infectious complications following prostate biopsy. We show that antibiotic prophylaxis is essential for prostate biopsy and that rectal preparation with povidone-iodine is mandatory.
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Affiliation(s)
- Adrian Pilatz
- Department of Urology, Paediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | | | - Bela Köves
- South-Pest Teaching Hospital, Department of Urology, Budapest, Hungary
| | - Tommaso Cai
- Santa Chiara Regional Hospital, Department of Urology, Trento, Italy
| | - Riccardo Bartoletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Florian Wagenlehner
- Department of Urology, Paediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Franck Bruyère
- Academic Department of Urology, CHRU Tours, François Rabelais University, Tours, France
| | - Suzanne Geerlings
- Division of Infectious Diseases, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Gernot Bonkat
- alta uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry (COB), University of Basel, Basel, Switzerland
| | - Benjamin Pradere
- Academic Department of Urology, CHRU Tours, François Rabelais University, Tours, France.
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Performance Validation of Selective Screening Agars for Guiding Antimicrobial Prophylaxis in Patients Undergoing Prostate Biopsy. J Clin Microbiol 2018; 56:JCM.00253-18. [PMID: 29899004 DOI: 10.1128/jcm.00253-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/11/2018] [Indexed: 11/20/2022] Open
Abstract
A rectal culture-guided antimicrobial prophylaxis strategy may prevent infections after transrectal ultrasound-guided prostate biopsy (TRUSP). The use of selective culture media could assist the choice of appropriate antibiotic prophylaxis. The objective of our study was to evaluate the performance of four selective media used for guidance of oral antibiotic prophylaxis in TRUSP. In this prospective validation study, we used MacConkey media with vancomycin plus one of the following antibiotics: ciprofloxacin (McC3+CIP/V), trimethoprim (McC3+TMP/V), fosfomycin (McC3+FOF/V), and amdinocillin-amoxicillin-clavulanic acid (McC3+MEC/V). First, clinical strains of Gram-negative bacilli (GNB) (n = 33) were evaluated for growth on the selective media. Thereafter, rectal swabs (n = 97) were randomly collected from residual material of fresh stool samples and plated on a growth control and the four selective media. Levels of recovery of GNB on the growth control and selective media were compared, and the MICs of the antibiotics used in this study were determined. The sensitivity and specificity of the four selective media amounted, respectively, to 90.0% (55.5 to 99.8%) and 98.7% (93.1 to 100.0%) for McC3+CIP/V, 95.7% (85.2 to 99.5%) and 100.0% (91.6 to 100.0%) for McC3+TMP/V, 95.5% (84.5 to 99.4%) and 97.8% (88.2 to 99.9%) for McC3+FOF/V, and 100.0% (76.8 to 100.0%) and 97.6% (87.4 to 99.9%) for McC3+MEC/V. In conclusion, the four selective media were sufficiently sensitive and specific for the identification of rectal GNB resistant to ciprofloxacin, trimethoprim, fosfomycin, or amdinocillin-amoxicillin-clavulanic acid. These media can have added value in streamlining the optimal culture based antibiotic prophylaxis in TRUSP in a non-labor-intensive manner.
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Fosfomycin vs. quinolone-based antibiotic prophylaxis for transrectal ultrasound-guided biopsy of the prostate: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2018; 21:153-160. [DOI: 10.1038/s41391-018-0032-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/06/2017] [Accepted: 11/20/2017] [Indexed: 11/08/2022]
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Roberts MJ, Scott S, Harris PN, Naber K, Wagenlehner FME, Doi SAR. Comparison of fosfomycin against fluoroquinolones for transrectal prostate biopsy prophylaxis: an individual patient-data meta-analysis. World J Urol 2017; 36:323-330. [PMID: 29288398 DOI: 10.1007/s00345-017-2163-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/22/2017] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To systematically review and meta-analyse available evidence comparing fosfomycin trometamol (FT) to fluoroquinolone (FQ) prophylaxis to prevent transrectal ultrasound-guided prostate biopsy (TRUSPB) related infectious complications. METHODS Electronic databases were queried for studies comparing FT to FQ-based TRUSPB prophylaxis. Studies were assessed for comparable outcomes and methodological quality (ROBINS-I modification). The primary outcome measure was the relative odds of overall infectious complications following TRUSPB according to FT/FQ treatment, which was evaluated with meta-analysis. Safety and tolerability were also assessed. The relative odds of infections of different severity [Grade 1, bacteriuria and afebrile urinary tract infection (UTI); Grade 2, bacteraemia, febrile UTI, and urosepsis] according to FT/FQ treatment were also estimated. RESULTS Five studies, being three prospective randomised trials and two retrospective cohort studies, representing 3112 patients, were included. The relative odds of an infectious complication (OR 0.22, 95% CI 0.09-0.54) or of a more severe (Grade 2) infection (OR 0.13, 95% CI 0.07-0.26) were significantly lower in those receiving FT compared to FQ prophylaxis. A low incidence of medication-related side effects was observed. There were less observed infections due to FQ-resistant pathogens in those receiving FT prophylaxis. CONCLUSIONS Patients who received FT prophylaxis were less likely than those who received FQ prophylaxis to develop infections overall, as well as severe and resistant infections after TRUSPB. Assessing the performance of FT in other geographic locations or in comparison to targeted prophylaxis based on risk assessment or rectal cultures is desired.
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Affiliation(s)
- Matthew J Roberts
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, Australia. .,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4006, Australia.
| | - Susan Scott
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Urology, Sunshine Coast University Hospital, Birtinya, Australia
| | - Patrick N Harris
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Microbiology, Central Laboratory, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Kurt Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Florian M E Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
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Pilatz A, Lüdecke G, Wagenlehner F. [Prophylaxis of infectious complications following prostate biopsy]. Urologe A 2017; 56:759-763. [PMID: 28455575 DOI: 10.1007/s00120-017-0392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Different strategies have been developed to reduce infectious complications following prostate biopsy. Various technical aspects like number of biopsies, needle size, route of biopsy, periprostatic nerve blockade, rectal preparation by enema, or disinfection with povidone-iodine have to be discussed. Regarding antibiotic therapy, choosing the optimal antibiotic, the duration of prophylaxis, combination therapy, and rectal swab-based antimicrobial therapy are of major interest. The current review gives answers to the different aspects.
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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.
| | - G Lüdecke
- 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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