Department of Urology, Cairo University, Cairo, Egypt.
Urology. 2011 Sep;78(3):511-4. doi: 10.1016/j.urology.2011.04.064. Epub 2011 Jul 22.
To evaluate the frequency and potential risk factors for infection-related complications after transrectal prostate biopsy and to propose adjustments in current antimicrobial prophylaxis recommendations.
During 2008-2010, 107 patients underwent transrectal ultrasound-guided biopsies of the prostate at our institution. Charts were reviewed for infection-related complications within 30 days of the procedure. Potential risk factors were evaluated, including age, diabetes mellitus, chronic constipation/diverticular disease, prior use of quinolones, enema and prostatitis, on the pathology report. For patients with acute prostatitis, urine and blood samples were assessed for bacteriology and antibiotic susceptibility.
Of our 107 patients, acute prostatitis developed in 10 (9.3%). The most significant risk factor was prior use of a fluoroquinolone antimicrobial, with acute prostatitis developing in 7 (17.1%) of 41 patients who had used a fluoroquinolone compared with 3 (4.5%) of 66 patients who had not (P=.042). Patients who received an enema before the procedure were slightly less likely to develop prostatitis (P=.061). Of 8 positive specimens, the organisms isolated were Escherichia coli in 6, Klebsiella pneumoniae in 1, and Staphylococcus epidermidis in one. Isolated Gram-negative organisms were fluoroquinolone-resistant in 85.7% of samples.
Prior fluoroquinolone intake is a significant risk factor behind a rising incidence of acute prostatitis after transrectal prostate biopsy. Identified pathogens are mostly Gram-negative organisms with a high rate of fluoroquinolone resistance. Alternative prophylaxis regimens for the biopsy procedure should be considered in patients with recent quinolone intake.
评估经直肠前列腺活检后与感染相关的并发症的发生频率和潜在危险因素，并对当前抗菌预防建议进行调整。
在 2008 年至 2010 年期间，我院对 107 例患者进行了经直肠超声引导前列腺活检。对术后 30 天内与感染相关的并发症进行了回顾性分析。评估了潜在的危险因素，包括年龄、糖尿病、慢性便秘/憩室病、既往使用氟喹诺酮类药物、灌肠和前列腺炎等，并在病理报告中进行了评估。对于患有急性前列腺炎的患者，对尿液和血液样本进行了细菌学和抗生素敏感性评估。
在我们的 107 例患者中，有 10 例（9.3%）发生了急性前列腺炎。最显著的危险因素是既往使用氟喹诺酮类抗菌药物，使用氟喹诺酮类药物的 41 例患者中有 7 例（17.1%）发生了急性前列腺炎，而未使用氟喹诺酮类药物的 66 例患者中有 3 例（4.5%）发生了急性前列腺炎（P=.042）。在接受检查前进行灌肠的患者发生前列腺炎的可能性略低（P=.061）。在 8 份阳性标本中，分离出的细菌包括大肠埃希菌 6 株、肺炎克雷伯菌 1 株和表皮葡萄球菌 1 株。分离出的革兰氏阴性菌在 85.7%的样本中对氟喹诺酮类药物耐药。
经直肠前列腺活检后急性前列腺炎发病率升高的一个显著危险因素是既往氟喹诺酮类药物的摄入。鉴定出的病原体主要为革兰氏阴性菌，对氟喹诺酮类药物的耐药率较高。对于近期有氟喹诺酮类药物摄入的患者，应考虑对活检术进行替代预防方案。
