Department of Urology, Henri Mondor Hospital, AP-HP, Paris-Est University, Créteil, France.
Int J Urol. 2014 Feb;21(2):152-5. doi: 10.1111/iju.12207. Epub 2013 Aug 1.
To evaluate the incidence, and clinical and bacterial features of iatrogenic prostatitis within 1 month after transrectal ultrasound-guided biopsy for detection of prostate cancer.
From January 2006 to December 2009, 3000 patients underwent a 21-core transrectal ultrasound-guided prostate biopsy at Henri Mondor Hospital (Créteil, France) and were prospectively followed. All patients had a fluoroquinolone antimicrobial prophylaxis for 7 days. The primary study end-point was to evaluate the incidence of iatrogenic acute prostatitis within 1 month after the biopsy. The secondary end-point was to analyze the clinical and the bacterial features of the prostatitis.
Overall, 20 patients of the entire study population (0.67%) had an acute bacterial prostatitis within 2.90 ± 1.77 days (range 1-7 days) after the transrectal ultrasound-guided biopsy. The groups of patients with (n = 20) and without (n = 2980) infection were similar in terms of age, prostate-specific antigen level and prostate volume. Escherichia coli was the only isolated bacteria. The subsequent tests for antibiotic susceptibility showed a 95% resistance for fluroquinolone and amoxicillin. Resistance to amoxiclav, trimethoprim-sulfamethoxazole, third generation cephalosporin and amikacin was 70%, 70%, 25% and 5% respectively. No resistance to imipenem was reported. They were all admitted for treatment without the need of intensive care unit referral. Complete recovery was achieved after 21.4 ± 7 days of antibiotic treatment.
A fluroquinolone-based regimen still represents an appropriate prophylaxis protocol to minimize the risk of acute prostatitis secondary to prostate biopsy. Patients should be provided the appropriate care soon after the onset of the symptoms. An intravenous third generation cephalosporin or imipenem-based therapy seem to provide satisfying results.
评估经直肠超声引导前列腺癌活检后 1 个月内医源性前列腺炎的发生率、临床和细菌特征。
2006 年 1 月至 2009 年 12 月，3000 例患者在 Henri Mondor 医院（法国克里泰）接受了 21 针经直肠超声引导前列腺活检，并进行了前瞻性随访。所有患者均接受 7 天氟喹诺酮类抗菌预防。主要研究终点是评估活检后 1 个月内医源性急性前列腺炎的发生率。次要终点是分析前列腺炎的临床和细菌特征。
在整个研究人群中，共有 20 例（0.67%）患者在经直肠超声引导活检后 2.90±1.77 天（1-7 天）内发生急性细菌性前列腺炎。有感染组（n=20）和无感染组（n=2980）在年龄、前列腺特异性抗原水平和前列腺体积方面相似。大肠杆菌是唯一分离的细菌。随后的抗生素药敏试验显示，氟喹诺酮类和阿莫西林的耐药率为 95%。对阿莫西林克拉维酸、复方磺胺甲噁唑、三代头孢菌素和阿米卡星的耐药率分别为 70%、70%、25%和 5%。未报告对亚胺培南的耐药性。所有患者均入院接受治疗，无需转入重症监护病房。抗生素治疗 21.4±7 天后完全康复。
基于氟喹诺酮类的方案仍然是一种合适的预防方案，可以最大限度地降低前列腺活检后发生急性前列腺炎的风险。患者应在症状出现后尽快获得适当的护理。静脉注射三代头孢菌素或亚胺培南为基础的治疗似乎能提供满意的效果。
