Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.
J Urol. 2013 Nov;190(5):1769-75. doi: 10.1016/j.juro.2013.04.134. Epub 2013 May 25.
We describe a simple and effective method to reduce the risk of infection after prostate biopsy.
A total of 1,642 consecutive prostate biopsy procedures during a 4-year period (2008 to 2012) were included in the study. Inclusion criteria consisted of pre-biopsy negative urine culture, bisacodyl enema and fluoroquinolone antibiotics (3 days). Formalin (10%) was used to disinfect the needle tip after each biopsy core. All patients were monitored for post-biopsy infection. The rate of infection was compared to that of a historical series of 990 procedures. Two ex vivo experiments were conducted to test the disinfectant effectiveness of formalin against fluoroquinolone resistant Escherichia coli, and another experiment was performed to quantitate formalin exposure.
Post-biopsy clinical sepsis with positive urine and blood cultures (quinolone resistant E. coli) developed in 2 patients (0.122%). Both patients were hospitalized, treated with intravenous antibiotics and had a full recovery without long-term sequelae. Mild uncomplicated urinary infection developed in 3 additional patients (0.183%). All were treated with outpatient oral antibiotics and had a complete recovery. The overall rate of urinary infection and sepsis using formalin disinfection was approximately a third of that of a prior series (0.30% vs 0.80%, p=0.13). Ex vivo experiments showed a complete lack of growth of fluoroquinolone resistant E. coli on blood and MacConkey agars after exposure to formalin. The amount of formalin exposure was negligible and well within the safe parameters of the Environmental Protection Agency.
Formalin disinfection of the biopsy needle after each prostate biopsy core is associated with a low incidence of urinary infection and sepsis. This technique is simple, effective and cost neutral.
我们描述了一种降低前列腺活检后感染风险的简单有效方法。
本研究共纳入了 4 年期间（2008 年至 2012 年）的 1642 例连续前列腺活检手术。纳入标准为活检前尿培养阴性、用比沙可啶灌肠和氟喹诺酮类抗生素（3 天）。每次活检后，用福尔马林（10%）对针尖进行消毒。所有患者均进行活检后感染监测。将感染率与 990 例历史系列手术进行比较。进行了两项离体实验，以测试福尔马林对氟喹诺酮类耐药大肠杆菌的消毒效果，另进行了一项实验以量化福尔马林暴露量。
2 例患者（0.122%）出现活检后临床脓毒症，尿液和血液培养阳性（氟喹诺酮类耐药大肠杆菌）。两名患者均住院，接受静脉内抗生素治疗，完全康复，无长期后遗症。另外 3 例患者出现轻度单纯性尿路感染（0.183%）。所有患者均接受门诊口服抗生素治疗，完全康复。使用福尔马林消毒的尿路感染和脓毒症总发生率约为前一系列的三分之一（0.30%对 0.80%，p=0.13）。离体实验显示，福尔马林暴露后，血琼脂和麦康凯琼脂上的氟喹诺酮类耐药大肠杆菌完全没有生长。福尔马林暴露量可忽略不计，远在环境保护署的安全参数范围内。
每次前列腺活检后用福尔马林消毒活检针与尿路感染和脓毒症发生率低有关。该技术简单、有效且成本中性。
