Rudzinski Jan Krzysztof, Kawakami Jun
Faculty of Medicine, University of Calgary, Calgary, AB;
Southern Alberta Institute of Urology, Calgary, AB.
Can Urol Assoc J. 2014 May;8(5-6):E301-5. doi: 10.5489/cuaj.1751.
We have seen an increased risk of infectious complications following transrectal ultrasound-guided prostate biopsy (TRUS-PB). Fluoroquinolone (FQ) antibiotics are common for prophylaxis prior to TRUS-PB. We evaluate whether increasing FQ resistance correlates with increased incidence of post-biopsy infectious complications at our institution.
We conducted a retrospective chart and electronic health record review on 927 patients who underwent TRUS-PB between January and July of 2012 in Calgary, Alberta, Canada. We prospectively collected the following variables: age, pre-biopsy prostate-specific antigen, and date of biopsy. We documented presentation to an emergency department within 30 days of TRUS-PB for infectious and non-infectious complications.
Of the 927 patients, 58 patients (6.3%) were admitted to the emergency department due to post-TRUS-PB complications within 30 days post-biopsy. The most common infectious complications were sepsis in 21 patients (2.2%), followed by urinary tract infection (UTI) in 9 (0.9%), and prostatitis in 4 (0.4%). We found that 83% of the septic episodes and 66.6% of the UTIs were attributed to ciprofloxacin resistant Escherichia coli (E. coli). The incidence of non-infectious complications was as follows: urinary retention in 12 (1.2%), hematuria in 9 (0.9%), and rectal bleeding in 8 (0.8%).
Our results suggest an increased incidence of infectious complications caused by FQ resistant organisms following TRUS-PB. This finding could be attributed to increasing community resistance to ciprofloxacin. The current antimicrobial prophylactic regimen needs to be re-evaluated, and a novel approach may need to be considered.
我们发现经直肠超声引导下前列腺穿刺活检（TRUS-PB）后感染并发症的风险有所增加。氟喹诺酮（FQ）类抗生素常用于TRUS-PB前的预防。我们评估在我们机构中，FQ耐药性增加是否与活检后感染并发症的发生率增加相关。
我们对2012年1月至7月在加拿大艾伯塔省卡尔加里接受TRUS-PB的927例患者进行了回顾性病历和电子健康记录审查。我们前瞻性地收集了以下变量：年龄、活检前前列腺特异性抗原和活检日期。我们记录了TRUS-PB后30天内因感染性和非感染性并发症到急诊科就诊的情况。
在927例患者中，58例（6.3%）在活检后30天内因TRUS-PB后并发症入住急诊科。最常见的感染并发症是21例（2.2%）败血症，其次是9例（0.9%）尿路感染（UTI）和4例（0.4%）前列腺炎。我们发现83%的败血症发作和66.6%的UTI归因于环丙沙星耐药的大肠杆菌（E. coli）。非感染性并发症的发生率如下：12例（1.2%）尿潴留，9例（0.9%）血尿，8例（0.8%）直肠出血。
我们的结果表明TRUS-PB后由FQ耐药菌引起的感染并发症发生率增加。这一发现可能归因于社区中环丙沙星耐药性的增加。当前的抗菌预防方案需要重新评估，可能需要考虑一种新的方法。
