Department of Urology, Northwestern University Feinberg School of Medicine, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL 60611, USA.
J Urol. 2012 Apr;187(4):1275-9. doi: 10.1016/j.juro.2011.11.115. Epub 2012 Feb 16.
We evaluated targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound guided prostate biopsy based on rectal swab culture results.
From July 2010 to March 2011 we studied differences in infectious complications in men who received targeted vs standard empirical ciprofloxacin prophylaxis before transrectal ultrasound guided prostate biopsy. Targeted prophylaxis used rectal swab cultures plated on selective media containing ciprofloxacin to identify fluoroquinolone resistant bacteria. Patients with fluoroquinolone susceptible organisms received ciprofloxacin while those with fluoroquinolone resistant organisms received directed antimicrobial prophylaxis. We identified men with infectious complications within 30 days after transrectal ultrasound guided prostate biopsy using the electronic medical record.
A total of 457 men underwent transrectal ultrasound guided prostate biopsy, and of these men 112 (24.5%) had rectal swab obtained while 345 (75.5%) did not. Among those who received targeted prophylaxis 22 (19.6%) men had fluoroquinolone resistant organisms. There were no infectious complications in the 112 men who received targeted antimicrobial prophylaxis, while there were 9 cases (including 1 of sepsis) among the 345 on empirical therapy (p=0.12). Fluoroquinolone resistant organisms caused 7 of these infections. The total cost of managing infectious complications in patients in the empirical group was $13,219. The calculated cost of targeted vs empirical prophylaxis per 100 men undergoing transrectal ultrasound guided prostate biopsy was $1,346 vs $5,598, respectively. Cost-effectiveness analysis revealed that targeted prophylaxis yielded a cost savings of $4,499 per post-transrectal ultrasound guided prostate biopsy infectious complication averted. Per estimation, 38 men would need to undergo rectal swab before transrectal ultrasound guided prostate biopsy to prevent 1 infectious complication.
Targeted antimicrobial prophylaxis was associated with a notable decrease in the incidence of infectious complications after transrectal ultrasound guided prostate biopsy caused by fluoroquinolone resistant organisms as well as a decrease in the overall cost of care.
我们评估了基于直肠拭子培养结果，对接受经直肠超声引导前列腺活检的男性进行靶向抗菌预防的效果。
从 2010 年 7 月至 2011 年 3 月，我们研究了接受靶向与标准经验性环丙沙星预防治疗的男性在经直肠超声引导前列腺活检后发生感染性并发症的差异。靶向预防使用直肠拭子培养物，这些培养物接种在含有环丙沙星的选择性培养基上，以鉴定氟喹诺酮类耐药菌。对氟喹诺酮敏感的患者给予环丙沙星，而对氟喹诺酮耐药的患者给予靶向抗菌预防。我们通过电子病历记录，在经直肠超声引导前列腺活检后 30 天内确定发生感染性并发症的患者。
共有 457 名男性接受了经直肠超声引导前列腺活检，其中 112 名（24.5%）进行了直肠拭子检查，345 名（75.5%）未进行直肠拭子检查。在接受靶向预防的患者中，22 名（19.6%）患者存在氟喹诺酮耐药菌。在接受靶向抗菌预防的 112 名患者中，无感染性并发症，而在接受经验性治疗的 345 名患者中，有 9 例（包括 1 例脓毒症）（p=0.12）。氟喹诺酮耐药菌引起了其中 7 例感染。在经验治疗组中，管理感染性并发症的总费用为 13,219 美元。每 100 名接受经直肠超声引导前列腺活检的男性，靶向与经验预防的总成本分别为 1,346 美元和 5,598 美元。成本效益分析显示，靶向预防可使每例经直肠超声引导前列腺活检后感染并发症的成本节省 4,499 美元。据估计，需要对 38 名男性进行直肠拭子检查，才能预防 1 例感染性并发症。
靶向抗菌预防可显著降低经直肠超声引导前列腺活检后由氟喹诺酮耐药菌引起的感染性并发症的发生率，并降低整体医疗费用。
