Yaghi Mohand Deeb, Kehinde E O
Ministry of Health in Kuwait, Al-Jahra Health Region, Saad Al-Abdullah Specialized Medical Institute, Kuwait University, Kuwait.
Urol Ann. 2015 Oct-Dec;7(4):417-27. doi: 10.4103/0974-7796.164860. Epub 2015 Oct 14.
For the diagnosis of prostate cancer trans-rectal prostate biopsy (TRPB) is used commonly, the procedure is associated with infective complications. There is evidence that antibiotics (ABx) decrease infective events after TRPB, but different regimens are used. To systematically review different regimens of prophylactic oral ABx in TRPB. MEDLINE, EMBASE, clinical trials site, and Cochrane library were searched, experts were consulted for relevant studies. Randomized clinical trials conducted in the last 20 years, which investigated the different oral antibiotic regimens in TRPB, and compared their efficacy to reduce infectious complications were analyzed. Primary outcomes were bacteriuria, urinary tract infection (UTI), fever, bacteremia, and sepsis. Secondary outcomes were the hospitalization rate and the prevalence of ABx-resistant bacteria. Nine trials were eligible with 3012 patients. ABx prevented bacteriuria (3.5% vs. 9.88%), UTI (4.46% vs. 9.75%), and hospitalization (0.21% vs. 2.13%) significantly in comparison with placebo or no treatment. No significant difference was found in all the outcomes of the review between the single dose regimen and the 3 days. The single dose regimen was as effective as the multiple doses except in bacteriuria (6.75% vs. 3.25%), and the prevalence of ABx-resistant bacteria (1.57% vs. 0.27%). Quinolones reduced only UTI significantly in comparison with other ABx (chloramphenicol, trimethoprim-sulfamethoxazol). It is essential to prescribe prophylactic ABx in TRPB. No conclusive evidence could be claimed about the superiority of the multiple or the 3 days regimens to the single dose regimen. Unexpectedly, ABx-resistant bacteria were identified more often in the single dose cohorts.
经直肠前列腺穿刺活检（TRPB）常用于前列腺癌的诊断，但该操作会引发感染性并发症。有证据表明，抗生素（ABx）可降低TRPB后的感染事件发生率，但使用的方案各不相同。为系统评价TRPB中预防性口服ABx的不同方案。检索了MEDLINE、EMBASE、临床试验网站和Cochrane图书馆，并向专家咨询了相关研究。分析了过去20年进行的随机临床试验，这些试验研究了TRPB中不同的口服抗生素方案，并比较了它们降低感染并发症的疗效。主要结局为菌尿、尿路感染（UTI）、发热、菌血症和败血症。次要结局为住院率和ABx耐药菌的发生率。9项试验符合纳入标准，共3012例患者。与安慰剂或不治疗相比，ABx显著预防了菌尿（3.5%对9.88%）、UTI（4.46%对9.75%）和住院（0.21%对2.13%）。单剂量方案和3天方案在本综述的所有结局中均未发现显著差异。除菌尿（6.75%对3.25%）和ABx耐药菌的发生率（1.57%对0.27%）外，单剂量方案与多剂量方案效果相同。与其他ABx（氯霉素、甲氧苄啶-磺胺甲恶唑）相比，喹诺酮类药物仅显著降低了UTI。在TRPB中开具预防性ABx至关重要。关于多剂量或3天方案优于单剂量方案，尚无确凿证据。出乎意料的是，在单剂量队列中更常发现ABx耐药菌。
