Gopal Rao G, Batura Deepak
Department of Microbiology, North West London Hospitals NHS Trust, Watford Road, London, HA1 3UJ, UK.
Int Urol Nephrol. 2014 Feb;46(2):309-15. doi: 10.1007/s11255-013-0529-5. Epub 2013 Aug 10.
To report the incidence of emergency admissions attributable to infective complications of transrectal ultrasound-guided prostate biopsy (TGB) and evaluate appropriateness of antimicrobial prophylaxis.
Retrospective cross-sectional study of patients undergoing TGB at the North West London Hospitals in 2009-2011. Demographic information of patients who had emergency admission within 30 days of TGB, length of hospital stay and microbiology results were obtained from the hospital's information system, medical records and laboratory information system. All patients received ciprofloxacin and amikacin prophylaxis.
1,419 TGB were performed in 1,276 patients. Forty-eight (3.3 %) patients had emergency admissions. Thirty-three (2.3 %) admissions were due to complications from TGB, while 15 (1 %) were for unrelated reasons. 30/33 (90 %, overall 2.1 %) of admissions from TGB complications were due to confirmed infections or systemic inflammatory response syndrome (SIRS). The rest were admitted with urinary retention. Admission rates due to TGB complications and infection/SIRS remained consistent over the 3 years (2009: TGB complications-2 %, TGB infection/SIRS-1.8 %; 2010: TGB complications-2.4 %, TGB infections/SIRS-2.2 %; 2011: TGB complications-2.6 %, TGB infection/SIRS-2.4 %; P > 0.05). All 11 cases with bacteraemia were caused by ciprofloxacin-resistant but amikacin-susceptible E. coli.
We observed a consistent rate of emergency admissions for complications following TGB; 90 % of these were due to infections. Ciprofloxacin-resistant but amikacin-sensitive E. coli was isolated in all bacteriologically confirmed infections. These results suggest that infective complications of TGB cannot be altogether eliminated despite appropriate antimicrobial prophylaxis. Therefore, additional strategies for reduction in biopsy-related admissions due to infections have to be considered.
报告经直肠超声引导下前列腺穿刺活检（TGB）感染性并发症导致的急诊入院发生率，并评估抗菌药物预防的合理性。
对2009年至2011年在伦敦西北部医院接受TGB的患者进行回顾性横断面研究。从医院信息系统、病历和实验室信息系统中获取TGB后30天内急诊入院患者的人口统计学信息、住院时间和微生物学结果。所有患者均接受环丙沙星和阿米卡星预防。
1276例患者共进行了1419次TGB。48例（3.3%）患者急诊入院。33例（2.3%）入院是由于TGB并发症，15例（1%）是由于无关原因。TGB并发症导致的33例入院中有30例（90%，总体2.1%）是由于确诊感染或全身炎症反应综合征（SIRS）。其余患者因尿潴留入院。TGB并发症和感染/SIRS导致的入院率在3年中保持一致（2009年：TGB并发症-2%，TGB感染/SIRS-1.8%；2010年：TGB并发症-2.4%，TGB感染/SIRS-2.2%；2011年：TGB并发症-2.6%，TGB感染/SIRS-2.4%；P>0.05）。所有11例菌血症病例均由耐环丙沙星但对阿米卡星敏感的大肠杆菌引起。
我们观察到TGB后并发症导致的急诊入院率一致；其中90%是由于感染。在所有经细菌学确诊的感染中均分离出耐环丙沙星但对阿米卡星敏感的大肠杆菌。这些结果表明，尽管进行了适当的抗菌药物预防，TGB的感染性并发症仍无法完全消除。因此，必须考虑采取其他策略以减少因感染导致的活检相关入院。
