Department of Urology, James Cook University Hospital, Middlesbrough, UK.
Department of Urology, Royal Preston Hospital, Preston, UK.
Prostate Cancer Prostatic Dis. 2018 Jun;21(2):153-160. doi: 10.1038/s41391-018-0032-2. Epub 2018 Feb 27.
Infection-related complications secondary to quinolone resistance have been on the rise following transrectal ultrasound-guided biopsy of the prostate (TRUSBP). The aim of this review was to compare the efficacy of fosfomycin with quinolone-based antibiotic prophylaxis for TRUSBP.
A systematic review in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and Cochrane guidelines was conducted. All studies comparing fosfomycin vs. non-fosfomycin antimicrobial prophylaxis for TRUSBP were considered. The main outcomes were number of urinary tract infections (UTIs) (overall, afebrile, febrile, and urosepsis) and fluoroqinolone resistance. Secondary outcomes were positive urine and blood cultures, and adverse effects of drugs.
Five studies comparing fosfomycin and non-fosfomycin antimicrobials were included in the review. In all, 1447 and 1665 patients were included in the fosfomycin and non-fosfomycin cohorts, respectively. The systematic review report significantly lower UTIs in the fosfomycin cohort (M-H, Fixed, 95% CI), 0.20 (0.13, 0.30), p < 0.00001. Urine cultures from patients given fosfomycin showed significantly lower resistance rates (M-H, Fixed, 95% CI) 0.27 (0.15, 0.50), p < 0.0001. The adverse effect profile between the two cohorts were similar (M-H, Fixed, 95% CI) 1.13 (0.51, 2.50), p = 0.33. On Grade Pro evaluation, overall UTI, afebrile UTI, febrile UTI, and urosepsis were rates as moderate, low, very low, and moderate quality evidence, respectively. Positive blood and urine culture were rated as moderate and very low-quality evidence, respectively. Fluoroquinolone resistance was rated as low-quality evidence. Adverse effects was rated as very low-quality evidence.
This review suggests that fosfomycin has significantly lower septic complications with an equivalent side effect profile in comparison with quinolone-based prophylaxis regimen for TRUSBP. There is an urgent need for appropriate antibiotic stewardship and it is paramount that studies with robust methodology are developed to establish the role of fosfomycin over existing antibiotic regimens for TRUSBP.
经直肠超声引导前列腺活检（TRUSBP）后，与喹诺酮类耐药相关的感染并发症呈上升趋势。本综述的目的是比较磷霉素与基于喹诺酮类的抗生素预防治疗 TRUSBP 的疗效。
按照系统评价和荟萃分析的首选报告项目（PRISMA）和 Cochrane 指南进行系统综述。所有比较磷霉素与非磷霉素抗菌预防治疗 TRUSBP 的研究均被纳入。主要结局为尿路感染（UTI）的数量（总体、无发热、发热和败血症）和氟喹诺酮类耐药。次要结局为尿液和血液培养阳性以及药物不良反应。
纳入了 5 项比较磷霉素和非磷霉素抗菌药物的研究。共有 1447 名和 1665 名患者分别纳入磷霉素和非磷霉素组。系统综述报告显示，磷霉素组 UTI 显著减少（M-H，固定，95%CI）0.20（0.13，0.30），p<0.00001。给予磷霉素的患者尿液培养显示出显著较低的耐药率（M-H，固定，95%CI）0.27（0.15，0.50），p<0.0001。两组的不良反应谱相似（M-H，固定，95%CI）1.13（0.51，2.50），p=0.33。在等级 Pro 评估中，总体 UTI、无发热 UTI、发热 UTI 和败血症的等级分别为中度、低、极低和中度质量证据。阳性血液和尿液培养的等级分别为中度和极低质量证据。氟喹诺酮类耐药的等级为低质量证据。不良反应的等级为极低质量证据。
本综述表明，与基于喹诺酮类的预防方案相比，磷霉素治疗 TRUSBP 可显著降低败血症并发症，且不良反应谱相当。迫切需要进行适当的抗生素管理，当务之急是制定出具有稳健方法学的研究，以确定磷霉素在现有抗生素方案治疗 TRUSBP 中的作用。
