Comprehensive Urogenital Cancer Center, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, 59, Liuting Street, Ningbo, Zhejiang, 315010, China.
School of medicine, Ningbo University, 818 Fenghua Road, Ningbo, Zhejiang, 315000, China.
Eur J Clin Microbiol Infect Dis. 2019 May;38(5):967-971. doi: 10.1007/s10096-019-03541-y. Epub 2019 Mar 27.
To develop an optimal prophylactic regimen among Chinese patients who accept transrectal prostate biopsy. We enrolled 420 patients who accepted transrectal prostate biopsy. They were randomly classified into three groups (n = 140 for each): Group A received a single 500-mg tablet of levofloxacin without enema; group B received a single 500-mg tablet of levofloxacin plus enema; group C received 3-day levofloxacin orally plus enema. Patients were assessed if they had a febrile urinary tract infection (FUTI). The incidence of FUTI was compared among groups. Subgroup analysis was performed between patients at high and low risk of infection in each group. There were 15 cases developed FUTI: 7 (5%), 6 (4.3%), and 2 (1.4%), respectively, in groups A, B, and C. Of the 15 patients who developed FUTI, Escherichia coli was detected in blood culture in two cases. Urine culture results were all negative. FUTI patients (73.3% (11/15)) had at least one high risk factor. Subgroup analysis showed that the incidence of FUTI in group A was significantly higher than that in group C among high-risk patients. There was no statistical difference between group A and group B among both high- and low-risk patients. A single 500-mg dose of levofloxacin without enema represents excellent prophylaxis for transrectal prostate biopsy in Chinese patients at low risk of infection. For those at high risk, 3-day levofloxacin prophylaxis is the optimal regimen. Prebiopsy enema provides no clinically significant outcome advantage and is unnecessary.
为了制定中国接受经直肠前列腺活检患者的最佳预防方案。我们纳入了 420 名接受经直肠前列腺活检的患者。他们被随机分为三组（每组 140 名）：A 组给予单次 500mg 左氧氟沙星片而不灌肠；B 组给予单次 500mg 左氧氟沙星片加灌肠；C 组给予口服 3 天左氧氟沙星加灌肠。评估患者是否发生发热性尿路感染（FUTI）。比较各组间 FUTI 的发生率。对每组感染高风险和低风险的患者进行亚组分析。共有 15 例发生 FUTI：A、B、C 组分别为 7（5%）、6（4.3%）和 2（1.4%）。15 例发生 FUTI 的患者中，有 2 例血培养检出大肠埃希菌。尿液培养结果均为阴性。FUTI 患者（73.3%（11/15））至少有 1 个高危因素。亚组分析显示，高风险患者中 A 组 FUTI 的发生率明显高于 C 组。高、低风险患者中 A 组与 B 组之间无统计学差异。单次 500mg 左氧氟沙星不灌肠对感染低风险的中国患者经直肠前列腺活检具有良好的预防作用。对于高风险患者，3 天左氧氟沙星预防方案是最佳方案。术前灌肠无临床显著获益，且无必要。
