Departments of Urology and *Microbiology, Northwick Park Hospital, London, and †Statistics, Modelling and Bioinformatics Department, Centre of Infections, Health Protection Agency, UK.
BJU Int. 2011 Mar;107(5):760-764. doi: 10.1111/j.1464-410X.2010.09715.x. Epub 2010 Oct 4.
• To examine the efficacy of adding amikacin to fluoroquinolone-based antimicrobial prophylaxis in preventing transrectal ultrasonography-guided prostate biopsy (TGB) associated infections.
• Infections after TGB were compared before adding amikacin to antimicrobial prophylaxis (2006) with those that occurred after adding amikacin to the prophylaxis (2007 and 2008). • During both periods antimicrobial prophylaxis consisted of ciprofloxacin, co-amoxiclav and metronidazole except after August 2008 when co-amoxiclav was discontinued. • Amikacin was added to the prophylaxis protocol in the period 2007 and 2008.
• Before adding amikacin 11 of 281 (3.9%) patients developed infections after TGB (seven urinary tract infections (UTIs) and seven bacteraemias) whereas after adding amikacin six UTIs and two bacteraemias occurred in 590 (1.4%) patients. • In both periods, most of the strains causing the infections were ciprofloxacin resistant (2006: 13 of 14; 2007 and 2008: seven of eight). • Overall, there is strong statistical evidence that the total infection rate was significantly reduced after the inclusion of amikacin into the prostate biopsy prophylaxis regimen. • In 2007 and 2008 when amikacin was included in prophylaxis, the bacteraemia rate was reduced to just over one-tenth of the rate in 2006 before introducing amikacin (P= 0.002). • Although just failing to reach the conventional significance level of 0.05, the evidence suggests a reduction in UTI by an estimated 60% after adding amikacin.
• We conclude that adding amikacin to fluoroquinolone-based antimicrobial prophylaxis in areas with high fluoroquinolone resistance confers significant benefit in preventing infections after TGB.
• 研究在氟喹诺酮类抗菌预防用药中添加阿米卡星预防经直肠超声引导前列腺活检（TGB）相关感染的疗效。
• 在添加阿米卡星至抗菌预防用药方案之前（2006 年）与添加阿米卡星之后（2007 年和 2008 年），对 TGB 后发生的感染进行了比较。• 在两个时期，抗菌预防用药均包括环丙沙星、复方新诺明和甲硝唑，2008 年 8 月之后不再使用复方新诺明。• 在 2007 年和 2008 年，阿米卡星被添加到预防方案中。
• 在添加阿米卡星之前，281 例患者中有 11 例（3.9%）发生 TGB 后感染（7 例尿路感染（UTI）和 7 例菌血症），而添加阿米卡星后，590 例（1.4%）患者中有 6 例发生 UTI 和 2 例菌血症。• 在两个时期，引起感染的大多数菌株对环丙沙星耐药（2006 年：14 株中的 13 株；2007 年和 2008 年：8 株中的 7 株）。• 总体而言，有强有力的统计证据表明，在将阿米卡星纳入前列腺活检预防方案后，总感染率显著降低。• 在 2007 年和 2008 年，当阿米卡星被纳入预防用药时，菌血症发生率降至引入阿米卡星之前的 2006 年的十分之一左右（P=0.002）。• 尽管尚未达到常规的 0.05 显著性水平，但证据表明，添加阿米卡星后，UTI 减少了约 60%。
• 我们得出结论，在氟喹诺酮类耐药率较高的地区，在氟喹诺酮类抗菌预防用药中添加阿米卡星可显著降低 TGB 后感染的风险。
