Dicker A P, Figura A T, Waterman F M, Valicenti R K, Strup S E, Gomella L G
Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107-5097, USA.
Tech Urol. 2000 Jun;6(2):104-8.
There are few data to guide the physician on the use of prophylactic antibiotic(s) for prostate brachytherapy. The purpose of this study was to evaluate the symptomatic urinary tract infection (UTI) rate after performing transperineal interstitial permanent prostate brachytherapy (TIPPB) in conjunction with cystoscopy.
One-hundred twenty-five patients underwent TIPPB and cystoscopy. All patients received intravenous perioperative antibiotic prophylaxis. No postimplant antibiotic medication was prescribed. All patients were evaluated at 1-month follow- up for symptomatic UTI. No screening (U/A, C+S) was performed for asymptomatic patients. Any UTI within 1 month of TIPPB was considered a complication and scored as an infection.
Of 125 patients who underwent TIPPB and cystoscopy, one patient (1%) developed a symptomatic UTI. In our study, a one-time perioperative intravenous dose of cefazolin (Ancef) without additional postoperative antibiotics resulted in an overall symptomatic UTI rate of 1%. Hence, additional postoperative antibiotics may not be warranted, thus providing a cost saving (500 mg of ciprofloxacin orally, two times a day for 5 days at a cost of $44.95) and reducing the potential risk of antibiotic resistance.
When cystoscopy is used in conjunction with TIPPB, perioperative antibiotic prophylaxis is recommended. However, due to the low infection rate expected from TIPPB, postimplant antibiotic use is not recommended. As a result of the low infection rate anticipated from TIPPB and cystoscopy, a large multiinstitutional trial is needed to determine the necessity of antibiotic prophylaxis for TIPPB and cystoscopy.
几乎没有数据可指导医生使用预防性抗生素进行前列腺近距离放射治疗。本研究的目的是评估经会阴间质永久性前列腺近距离放射治疗（TIPPB）联合膀胱镜检查后的有症状尿路感染（UTI）发生率。
125例患者接受了TIPPB和膀胱镜检查。所有患者均接受围手术期静脉注射抗生素预防。未开具植入后抗生素药物。所有患者在1个月随访时评估有无症状性UTI。未对无症状患者进行筛查（尿常规、尿培养+药敏）。TIPPB后1个月内发生的任何UTI均被视为并发症并计为感染。
在125例接受TIPPB和膀胱镜检查的患者中，1例（1%）发生了有症状的UTI。在我们的研究中，围手术期一次性静脉注射头孢唑林（安赛福）且术后不使用额外抗生素，导致总体有症状UTI发生率为1%。因此，可能无需额外的术后抗生素，从而节省成本（口服500 mg环丙沙星，每日两次，共5天，费用为44.95美元）并降低抗生素耐药性的潜在风险。
当膀胱镜检查与TIPPB联合使用时，建议进行围手术期抗生素预防。然而，由于TIPPB预期的感染率较低，不建议使用植入后抗生素。鉴于TIPPB和膀胱镜检查预期的感染率较低，需要进行一项大型多机构试验来确定TIPPB和膀胱镜检查抗生素预防的必要性。
