Luong Benjamin, Danforth Teresa, Visnjevac Ognjen, Suraf Margaret, Duff Michael, Chevli K Kent
Department of Urology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY.
Department of Urology, the Western New York Urology Associates, LLC, Cheektowaga, NY.
Urology. 2015 Mar;85(3):511-6. doi: 10.1016/j.urology.2014.10.047. Epub 2015 Jan 14.
To evaluate the hospitalization rates in 2 pre-prostate biopsy antibiotic protocols.
Two prebiopsy protocols were compared. CiproAlone required ciprofloxacin 500 mg twice daily starting 1 day before biopsy and continuing for 3 days after biopsy (4 days total). Diabetic patients were prescribed ciprofloxacin for 4 days after biopsy. CiproCeft required 1 dose of oral ciprofloxacin 500 mg 1 hour before the biopsy and ceftriaxone 1 g intramuscular at the time of the biopsy. Hospitalization rates between the CiproAlone vs CiproCeft protocols were examined.
A total of 4134 biopsies were identified-2093 in the CiproAlone cohort and 2041 in the CiproCeft cohort. The post-prostate biopsy infection hospitalization rate was 0.6% (14 patients) in the CiproAlone group vs 0.0% (0 patients) in the CiproCeft group (P <.0001). Of the patients hospitalized, 12 fit systemic inflammatory response syndrome (SIRS) criteria. Eight of 14 hospitalized patients fit the sepsis (SIRS and source of infection) criteria. Positive cultures (urine and/or blood) resulted from 71% (n = 10) of hospitalized patients. Antibiotic resistance was analyzed. Diabetes mellitus was associated with hospitalization after prostate biopsy (P = .01) in our population, but there was no difference between the 2 groups in the rates of diabetes mellitus (P = .46). Patient age, prostate-specific antigen level, number of biopsy cores obtained, race, and previous antibiotics exposure were not found to be independent predictors of post-transrectal ultrasonography biopsy hospitalization for infection using a multivariate regression analysis.
A prophylactic prebiopsy protocol including 2 classes of antibiotics, single-dose ciprofloxacin, and single-dose intramuscular ceftriaxone reduced post-transrectal ultrasonography biopsy rates of hospitalizations compared to oral ciprofloxacin alone.
评估两种前列腺活检前抗生素方案的住院率。
比较两种活检前方案。“单用环丙沙星”方案要求在活检前1天开始每日两次口服500毫克环丙沙星，并在活检后持续3天（共4天）。糖尿病患者在活检后服用环丙沙星4天。“环丙沙星联合头孢曲松”方案要求在活检前1小时口服1剂500毫克环丙沙星，并在活检时肌内注射1克头孢曲松。检查“单用环丙沙星”方案与“环丙沙星联合头孢曲松”方案之间的住院率。
共识别出4134例活检病例，“单用环丙沙星”队列中有2093例，“环丙沙星联合头孢曲松”队列中有2041例。“单用环丙沙星”组前列腺活检后感染住院率为0.6%（14例患者），“环丙沙星联合头孢曲松”组为0.0%（0例患者）（P<.0001）。在住院患者中，12例符合全身炎症反应综合征（SIRS）标准。14例住院患者中有8例符合脓毒症（SIRS和感染源）标准。71%（n=10）的住院患者培养结果呈阳性（尿液和/或血液）。分析了抗生素耐药性。在我们的研究人群中，糖尿病与前列腺活检后住院相关（P=.01），但两组之间的糖尿病发生率无差异（P=.46）。使用多因素回归分析未发现患者年龄、前列腺特异性抗原水平、获取的活检芯数量、种族和既往抗生素暴露是经直肠超声引导活检后感染住院的独立预测因素。
与单用口服环丙沙星相比，一种包括两类抗生素、单剂量环丙沙星和单剂量肌内注射头孢曲松的预防性活检前方案降低了经直肠超声引导活检后的住院率。
