Summers Stephen J, Patel Darshan P, Hamilton Blake D, Presson Angela P, Fisher Mark A, Lowrance William T, Southwick Andrew W
Division of Urology, Department of Surgery, University of Utah Health Care, University of Utah, 30 N 1900 E, RM 3B420, Salt Lake City, UT, 84132, USA.
George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA.
World J Urol. 2015 Dec;33(12):2001-7. doi: 10.1007/s00345-015-1571-y. Epub 2015 May 3.
To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy in our Veterans Affairs population.
Between June 1, 2013, and June 1, 2014, we implemented an antimicrobial prophylaxis protocol using rectal swab cultures on selective media containing ciprofloxacin for all men scheduled for TRUS-guided prostate biopsy. Data from 2759 patients from Jan 1, 2006 to May 31, 2013, before protocol implementation served as historical controls. Patients with fluoroquinolone (FQ)-susceptible organisms received FQ monotherapy, while those with FQ-resistant organisms received targeted prophylaxis. Our objective was to compare the rate of infectious complications 30 days after prostate biopsy before and after implementation of our antimicrobial protocol.
One hundred and sixty-seven patients received rectal swab cultures using our protocol. Seventeen (14 %) patients had FQ-resistant positive cultures. Patients with positive FQ-resistant culture results were more likely to have had a history of previous prostate biopsy and a positive urine culture in the last 12 months (p = 0.032, p = 0.018, respectively). The average annual infectious complication rate within 30 days of biopsy was reduced from 2.8 to 0.6 % before and after implementation of our antimicrobial prophylaxis protocol using rectal swab cultures, although this difference was not statistically significant (p = 0.13).
An antimicrobial prophylaxis protocol using rectal culture swabs is a viable option for prevention of TRUS-guided prostate biopsy infectious complications. After implementation of an antimicrobial prophylaxis protocol, we observed a nonsignificant decrease in the rate of post-biopsy infectious complications when compared to historical controls.
评估在我们退伍军人事务人群中，对接受经直肠超声（TRUS）引导前列腺穿刺活检的患者采用直肠拭子培养进行抗菌预防方案的益处。
在2013年6月1日至2014年6月1日期间，我们对所有计划接受TRUS引导前列腺穿刺活检的男性，采用在含环丙沙星的选择性培养基上进行直肠拭子培养的抗菌预防方案。2006年1月1日至2013年5月31日期间2759例患者的数据作为实施该方案前的历史对照。对氟喹诺酮（FQ）敏感菌的患者接受FQ单药治疗，而对FQ耐药菌的患者接受针对性预防。我们的目标是比较实施抗菌方案前后前列腺穿刺活检后30天感染并发症的发生率。
167例患者按照我们的方案进行了直肠拭子培养。17例（14%）患者培养出FQ耐药阳性菌。FQ耐药培养结果阳性的患者更可能有既往前列腺穿刺活检史以及过去12个月内尿培养阳性（分别为p = 0.032，p = 0.018）。在采用直肠拭子培养的抗菌预防方案实施前后，活检后30天内的平均年感染并发症发生率从2.8%降至0.6%，尽管这种差异无统计学意义（p = 0.13）。
采用直肠培养拭子的抗菌预防方案是预防TRUS引导前列腺穿刺活检感染并发症的一个可行选择。在实施抗菌预防方案后，与历史对照相比，我们观察到活检后感染并发症发生率有非显著性下降。
