Kim Sang Jin, Kim Sun Il, Ahn Hyun Soo, Choi Jong Bo, Kim Young Soo, Kim Se Joong
Department of Urology, Ajou University School of Medicine, Suwon, Korea.
Korean J Urol. 2010 Jun;51(6):426-30. doi: 10.4111/kju.2010.51.6.426. Epub 2010 Jun 21.
To investigate the incidence, clinical features, pathogenic bacteria, and risk factors associated with acute prostatitis after transrectal prostate biopsy.
We retrospectively reviewed the medical records of 923 transrectal ultrasound-guided needle biopsies of the prostate in 878 patients performed at our institution from June 2004 to May 2009. The indications for biopsy were generally serum prostate-specific antigen (PSA) elevation, abnormal findings on a digital rectal examination, or both. All biopsies were performed with the patient hospitalized except for 10 patients who refused to be hospitalized, and ciprofloxacin was administered as an antibiotic prophylaxis. The incidence, clinical features, pathogenic bacteria, and potential risk factors associated with acute prostatitis after prostate biopsy were evaluated.
Acute prostatitis developed in 18 (2.0%) cases after prostate biopsy. Among them, 9 (1.0%) had bacteremia and 2 (0.2%) showed clinical features of sepsis. Of the total 50 urine or blood specimens sent for culture study, 27 (54.0%) specimens showed positive cultures, including E. coli in 25. Among the 27 culture-positive specimens, 26 (96.3%) were resistant to ciprofloxacin. Among the potential risk factors for acute prostatitis after prostate biopsy, biopsy performed as an outpatient procedure without a cleansing enema (p=0.001) and past history of cerebrovascular accident (p=0.048) were statistically significant.
Fluoroquinolone is effective as an antibiotic prophylaxis for transrectal prostate biopsy in most cases. The incidence of acute prostatitis after transrectal prostate biopsy was 2.0%, and almost all cases were caused by fluoroquinolone-resistant E. coli. A cleansing enema is recommended before transrectal prostate biopsy.
探讨经直肠前列腺穿刺活检后急性前列腺炎的发生率、临床特征、病原菌及相关危险因素。
我们回顾性分析了2004年6月至2009年5月在本机构对878例患者进行的923次经直肠超声引导下前列腺穿刺活检的病历。活检指征一般为血清前列腺特异性抗原（PSA）升高、直肠指检异常或两者兼有。除10例拒绝住院的患者外，所有活检均在患者住院期间进行，并给予环丙沙星作为抗生素预防用药。评估前列腺穿刺活检后与急性前列腺炎相关的发生率、临床特征、病原菌及潜在危险因素。
前列腺穿刺活检后18例（2.0%）发生急性前列腺炎。其中，9例（1.0%）发生菌血症，2例（0.2%）出现脓毒症临床特征。在送检培养研究的50份尿液或血液标本中，27份（54.0%）标本培养阳性，其中25份为大肠杆菌。在27份培养阳性标本中，26份（96.3%）对环丙沙星耐药。在前列腺穿刺活检后急性前列腺炎的潜在危险因素中，门诊进行活检且未行清洁灌肠（p = 0.001）和既往有脑血管意外病史（p = 0.048）具有统计学意义。
氟喹诺酮类药物在大多数情况下作为经直肠前列腺穿刺活检的抗生素预防用药是有效的。经直肠前列腺穿刺活检后急性前列腺炎的发生率为2.0%，几乎所有病例均由耐氟喹诺酮类大肠杆菌引起。建议在经直肠前列腺穿刺活检前进行清洁灌肠。
