Woldu Solomon L, Hutchinson Ryan C, Singla Nirmish, Hornberger Brad, Roehrborn Claus G, Lotan Yair
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas USA.
Urol Pract. 2018 Mar;5(2):124-131. doi: 10.1016/j.urpr.2017.03.002. Epub 2017 Mar 18.
A number of strategies have been attempted to minimize infection risk following transrectal prostate procedures (TRPXs). We report our prospective efforts at augmenting our prophylaxis strategy over time.
Since 2010, we prospectively monitor post-TRPX infections and changed our prophylaxis regimen twice in an effort to respond to increases in infectious complications. In 2011 we added a single-dose of intramuscular (IM) aminoglycoside to our prophylaxis regimen of fluoroquinolones (FQ) or trimethoprim-sulfamethoxazole. In 2015 we began performing formalin needle-tip disinfection before each biopsy and screening high-risk patients for antibiotic resistance using rectal swab cultures (targeted prophylaxis). We report our rates of infections and antibiotic resistance patterns over this period.
From 2010-2016, we performed 2398 TRPXs; overall, there were 41 cases (1.7%) of infection-related hospitalization, however the rate differed significantly over the study period. The infection-related hospitalization rate declined from 3.8 to 1.1% in the first 3 years following the addition of IM aminoglycoside (2011-2013) - a decrease of 69%. In 2014 our infection rate increased to 2.6% prompting initiation of protocol #3 wherein the addition of target prophylaxis and formalin needle-tip disinfection identified a 29.8% FQ-resistance rate and resulted in another decline in our infection rate to 1.2% - a decrease of 53%.
While the initial addition of IM aminoglycoside appeared to be effective in decreasing post-procedure infections, further augmentation of our prophylaxis regimen through rectal swab screening of high-risk patients and formalin needle-tip disinfection led to an additional decline in rates of infection-related hospitalizations.
为将经直肠前列腺手术（TRPXs）后的感染风险降至最低，人们尝试了多种策略。我们报告了随着时间推移加强预防策略的前瞻性努力。
自2010年以来，我们前瞻性监测TRPXs后的感染情况，并两次更改预防方案，以应对感染并发症的增加。2011年，我们在氟喹诺酮类（FQ）或甲氧苄啶-磺胺甲恶唑的预防方案中添加了单剂量肌内注射（IM）氨基糖苷类药物。2015年，我们开始在每次活检前进行福尔马林针尖消毒，并使用直肠拭子培养对高危患者进行抗生素耐药性筛查（靶向预防）。我们报告了这一时期的感染率和抗生素耐药模式。
2010年至2016年，我们共进行了2398例TRPXs；总体而言，有41例（1.7%）因感染住院，但该比率在研究期间有显著差异。添加IM氨基糖苷类药物后的前3年（2011 - 2013年），感染相关住院率从3.8%降至1.1%，降幅达69%。2014年，我们的感染率升至2.6%，促使启动方案3，其中添加靶向预防和福尔马林针尖消毒后，FQ耐药率为29.8%，感染率再次降至1.2%，降幅为53%。
虽然最初添加IM氨基糖苷类药物似乎有效降低了术后感染，但通过对高危患者进行直肠拭子筛查和福尔马林针尖消毒进一步加强我们的预防方案，导致感染相关住院率进一步下降。
