Atılgan Doğan, Gençten Yusuf, Kölükçü Engin, Kılıç Şahin, Uluocak Nihat, Parlaktaş Bekir Süha, Erdemir Fikret
Department of Urology, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey.
Turk J Urol. 2015 Mar;41(1):27-31. doi: 10.5152/tud.2015.22120.
The aim of this study was to compare the efficacies of oral ciprofloxacin administration and oral trimethoprim-sulfamethoxazole (TMP-SMX) regimens in preventing infectious complications following transrectal ultrasound guided biopsy of the prostate.
Between 2011-2013, the medical records of 391 (mean age 64.62±7.64 years; range 40 to 87 years) patients who underwent transrectal prostate biopsies, due to suspicion of prostate cancer were retrospectively reviewed. While 500 mg ciprofloxacin was given orally twice daily starting one day before the procedure, continued for 3 days in the first 174 patients (group 1); was given orally twice daily starting one day before the procedure, continued for 3 days in the remaining 217 patients (group 2) for prophylaxis. Urine samples were obtained for urine culture before the procedure. The two groups were compared with respect to findings of urine cultures performed before and after the procedure and complications.
In the ciprofloxacin and groups, any positive urine culture before the procedure was not observed. Complications occured in 93 patients (37 in group 1 and 56 in group 2), after the procedure. Twenty-two (5.6%) (11 in group 1 and 11 in group 2). patients were admitted to our clinic because of high fever occurring after biopsy. Nine ciprofloxacin-treated (5.2%) and 16 TMP-SMX-treated (7.4%) patients had severe dysuria after the procedure. Twenty-one ciprofloxacin recipients (12.1%) and 40 TMP-SMX recipients (18.4%) had macroscopic hematuria. In the ciprofloxacin and TMP-SMX groups, the incidences of new culture positivity were 4% (n=7) and 2.8% (n=6) after the procedure, respectively. All of the isolated bacteria was Escherichia coli. While 11 patients were hospitalized due to signs of complicated urinary tract infections, and 2 patients were treated as outpatients. Rectal bleeding that did not require any intervention was observed in a patient 8 hours after biopsy. SIRS findings were detected in two patients. There were no significant differences between the two groups with respect to age, prostate volume, prostate spesific antigen (PSA) levels, and results of urine culture performed after the procedure (p>0.05).
Despite the increasing resistance to antibiotics, ciprofloxacin and TMP-SMX are effective prophylactic treatment modalities for transrectal prostate biopsy. Both three-day ciprofloxacin and TMP-SMX regimens seem to be equally effective in the antibiotic prophylaxis for transrectal prostate biopsy.
本研究旨在比较口服环丙沙星与口服甲氧苄啶-磺胺甲恶唑（TMP-SMX）方案在预防经直肠超声引导下前列腺穿刺活检后感染性并发症方面的疗效。
回顾性分析2011年至2013年间391例（平均年龄64.62±7.64岁；范围40至87岁）因怀疑前列腺癌而行经直肠前列腺穿刺活检患者的病历。在第174例患者（第1组）中，于穿刺前一天开始每日口服500mg环丙沙星两次，持续3天；在其余217例患者（第2组）中，同样于穿刺前一天开始每日口服两次，持续3天以进行预防。在穿刺前获取尿液样本进行尿培养。比较两组穿刺前后尿培养结果及并发症情况。
在环丙沙星组和TMP-SMX组中，穿刺前均未观察到尿培养阳性。穿刺后93例患者出现并发症（第1组37例，第2组56例）。22例（5.6%）（第1组11例，第2组11例）患者因穿刺后高热入院。9例接受环丙沙星治疗的患者（5.2%）和16例接受TMP-SMX治疗的患者（7.4%）穿刺后出现严重尿痛。21例接受环丙沙星治疗的患者（12.1%）和40例接受TMP-SMX治疗的患者（18.4%）出现肉眼血尿。在环丙沙星组和TMP-SMX组中，穿刺后新的培养阳性发生率分别为4%（n = 7）和2.8%（n = 6）。所有分离出的细菌均为大肠杆菌。11例患者因复杂性尿路感染体征住院，2例患者门诊治疗。1例患者在穿刺活检8小时后出现无需任何干预的直肠出血。2例患者检测到全身炎症反应综合征（SIRS）表现。两组在年龄、前列腺体积、前列腺特异性抗原（PSA）水平及穿刺后尿培养结果方面无显著差异（p>0.05）。
尽管抗生素耐药性不断增加，但环丙沙星和TMP-SMX是经直肠前列腺穿刺活检有效的预防性治疗方式。为期三天的环丙沙星和TMP-SMX方案在经直肠前列腺穿刺活检的抗生素预防方面似乎同样有效。
