Department of Surgery (Division of Urology), Faculty of Medicine, Kuwait University, Kuwait.
J Urol. 2013 Mar;189(3):911-5. doi: 10.1016/j.juro.2012.08.237. Epub 2012 Sep 23.
A steady increase in the incidence of septicemia after prostate biopsy in our unit between 2001 and 2005 prompted us to review our prophylactic antibiotic regimen. We compared the incidence of septicemia in patients undergoing prostate biopsy between 2001 and 2005 when only oral ciprofloxacin was used prophylactically (group 1) to the incidence among patients undergoing biopsy between 2006 and 2010 when a single dose of intravenous amikacin was added to ciprofloxacin (group 2).
In group 1 the 300 patients were given 500 mg oral ciprofloxacin twice daily 1 day before and for 2 days after the biopsy while in group 2 the 897 patients, in addition to the ciprofloxacin previously mentioned, received 500 mg intravenous amikacin 30 minutes before the biopsy. Patients admitted to the hospital with septicemia after prostate biopsy had urine and blood culture and sensitivity tests. The number of patients in whom septicemia developed in each group after prostate biopsy and the microorganisms isolated from the urine and blood of such patients were compared using the chi-square test.
Septicemia was seen in 24 of 300 (8%) and 15 of 897 (1.7%) patients in groups 1 and 2, respectively (p <0.001). In group 1 the rate of septicemia after prostate biopsy was 2.1% and 13% in 2001 and 2005, respectively (p <0.001). In group 2 the rate of septicemia was 1.5% in 2006 and 1.6% in 2010 (p <0.25). Escherichia coli resistant to quinolones was responsible for 33 of 39 (84.6%) septicemic cases.
The addition of amikacin to ciprofloxacin prophylaxis significantly reduces the incidence of septicemia after prostate biopsy.
在我们科室，2001 年至 2005 年间，前列腺活检后脓毒症的发生率持续上升，促使我们重新审查了预防性抗生素方案。我们比较了 2001 年至 2005 年间仅口服环丙沙星预防性治疗的前列腺活检患者（第 1 组）和 2006 年至 2010 年间环丙沙星加阿米卡星单次静脉注射的前列腺活检患者（第 2 组）的脓毒症发生率。
第 1 组 300 例患者在活检前 1 天和活检后 2 天内每天口服环丙沙星 500mg，2 次；第 2 组 897 例患者除上述环丙沙星外，还在活检前 30 分钟内静脉注射阿米卡星 500mg。前列腺活检后因脓毒症住院的患者进行了尿和血培养及药敏试验。使用卡方检验比较每组前列腺活检后发生脓毒症的患者人数以及从这些患者的尿液和血液中分离出的微生物。
第 1 组和第 2 组分别有 24 例（8%）和 15 例（1.7%）患者发生脓毒症（p<0.001）。第 1 组前列腺活检后脓毒症的发生率分别为 2001 年 2.1%和 2005 年 13%（p<0.001）。第 2 组 2006 年和 2010 年脓毒症发生率分别为 1.5%和 1.6%（p<0.25）。对喹诺酮类药物耐药的大肠杆菌导致 39 例脓毒症病例中的 33 例（84.6%）。
在环丙沙星预防性治疗中加入阿米卡星可显著降低前列腺活检后的脓毒症发生率。
