Department of Urology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan,
J Infect Chemother. 2013 Oct;19(5):926-30. doi: 10.1007/s10156-013-0610-0. Epub 2013 May 4.
To propose an appropriate prophylactic antimicrobial therapy for patients undergoing brachytherapy, we evaluated the relationships between various antimicrobial prophylaxis (AMP) protocols and the incidence of postimplant infections in a multicenter cohort study conducted in Japan. The records of 826 patients with localized prostate cancer who underwent a transperineal (125)I brachytherapy procedure between January 2009 and December 2010 were retrospectively reviewed. Perioperative infections, including surgical site and remote infections, were recorded up to postoperative day 30. A total of 6 (0.73%) patients had a perioperative infection following seed implantation, of whom all received AMP for 1 or more days. None of the patients who received a single-dose protocol of AMP using fluoroquinolone p.o. or penicillin with a beta-lactamase inhibitor i.v. developed a perioperative infection. Statistical analysis showed that a single-dose protocol was more significantly related to a lower risk of perioperative infection as compared to the other AMP protocols examined (p = 0.045). Furthermore, our results indicated that bacteriuria and preoperative hair removal were risk factors of perioperative infection with statistical significance (p = 0.007, p = 0.004). Analysis of patient clinical parameters, including age, American Society of Anesthesiologists score, diabetes mellitus, prostate volume, numbers of implanted seeds and needle punctures, operation time, and indwelling duration time of the Foley catheter, did not reveal significant differences in terms of perioperative infection. Our results indicated that a single-dose AMP protocol is sufficient to prevent perioperative infections following seed implantation. On the other hand, AMP is only one of several measures to prevent perioperative infectious complications. It is necessary to know that the patient must have no bacteriuria and that preoperative hair removal should be avoided.
为了为接受近距离放射治疗的患者提出适当的预防性抗菌治疗方案，我们在日本进行的一项多中心队列研究中评估了各种抗菌预防（AMP）方案与植入后感染发生率之间的关系。回顾性分析了 2009 年 1 月至 2010 年 12 月间接受经会阴（125）I 近距离放射治疗的 826 例局限性前列腺癌患者的记录。记录了围手术期感染，包括手术部位和远处感染，直至术后第 30 天。共有 6 名（0.73%）患者在种子植入后发生围手术期感染，所有患者均接受了 1 天或更长时间的 AMP。接受口服氟喹诺酮类药物或静脉注射含β-内酰胺酶抑制剂的青霉素单次剂量 AMP 方案的患者均未发生围手术期感染。统计学分析表明，与其他研究的 AMP 方案相比，单次剂量方案与围手术期感染风险降低显著相关（p = 0.045）。此外，我们的结果表明，菌尿症和术前剃毛是围手术期感染的危险因素，具有统计学意义（p = 0.007，p = 0.004）。对患者的临床参数（包括年龄、美国麻醉医师协会评分、糖尿病、前列腺体积、植入种子和针穿刺数、手术时间和 Foley 导管留置时间）进行分析，未发现围手术期感染方面存在显著差异。我们的结果表明，单次剂量 AMP 方案足以预防种子植入后的围手术期感染。另一方面，AMP 只是预防围手术期感染性并发症的几项措施之一。有必要知道患者不能有菌尿症，并且应避免术前剃毛。
