Mann Mark, Calio Brian P, Mark James Ryan, Chelluri Raju, Hufnagel Erich, Reese Adam, Lallas Costas D, Trabulsi Edouard J, Chandrasekar Thenappan, Shenot Patrick J, Halpern Ethan, Gomella Leonard G
Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Can J Urol. 2020 Feb;27(1):10099-10104.
To assess whether standard American Urological Association (AUA) and other recommendations for prostate biopsy prophylaxis provide sufficient coverage of common urinary organisms responsible for post biopsy infections by comparing local antibiograms in Philadelphia-area hospitals.
De-identified culture results derived from antibiograms were collected from six academic and community hospitals in the Philadelphia region. Analysis specifically focused on four major bacterial causes of urinary tract infection following prostate biopsy (Escherichia coli (E. coli), Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis) along with commonly recommended antibiotics including fluoroquinolones (FQ's), trimethoprim/sulfamethoxazole, ceftriaxone, and gentamicin.
Bacterial sensitivities to each antibiotic across institutions showed variation in E.coli sensitivities to FQs (p < 0.001), trimethoprim/sulfamethoxazole (p < 0.001), ceftriaxone (p < 0.001) and gentamicin (p < 0.001). Klebsiella pneumoniae and Proteus mirabilis exhibited similar variations. Sensitivity comparisons for Enterococcus faecalis was unable to be performed due to absent or incomplete data across institutions.
Institutional antibiograms vary within our regional hospitals. Standardized recommendations for commonly used antibiotic prophylaxis such as fluoroquinolones may be inadequate for peri-procedural prostate biopsy prophylaxis based on local resistance patterns. Valuable information about the potential effectiveness of antibiotic prophylaxis for prostate biopsies can be found in local institutional antibiograms, and should be consulted when considering antibiotic prophylaxis for prostate biopsy procedures.
通过比较费城地区医院的当地抗菌谱，评估美国泌尿外科学会（AUA）的标准及其他前列腺活检预防建议是否能充分覆盖导致活检后感染的常见尿路病原体。
从费城地区的六家学术和社区医院收集来自抗菌谱的匿名培养结果。分析特别关注前列腺活检后尿路感染的四种主要细菌病因（大肠杆菌、肺炎克雷伯菌、奇异变形杆菌和粪肠球菌）以及常用推荐抗生素，包括氟喹诺酮类（FQ）、甲氧苄啶/磺胺甲恶唑、头孢曲松和庆大霉素。
各机构中每种抗生素的细菌敏感性显示，大肠杆菌对FQ（p < 0.001）、甲氧苄啶/磺胺甲恶唑（p < 0.001）、头孢曲松（p < 0.001）和庆大霉素（p < 0.001）的敏感性存在差异。肺炎克雷伯菌和奇异变形杆菌表现出类似的差异。由于各机构数据缺失或不完整，无法对粪肠球菌进行敏感性比较。
我们地区医院的机构抗菌谱各不相同。基于当地耐药模式，如氟喹诺酮类等常用抗生素预防的标准化建议可能不足以用于前列腺活检围手术期的预防。关于前列腺活检抗生素预防潜在有效性的有价值信息可在当地机构抗菌谱中找到，在考虑前列腺活检手术的抗生素预防时应参考这些信息。
