Department of Medical Microbiology, Radboud Center Infectious Diseases, Radboudumc, huispost 777, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
Department of Urology, Catharina Hospital, Eindhoven, the Netherlands.
BMC Urol. 2020 Mar 12;20(1):24. doi: 10.1186/s12894-020-00592-8.
The clinical landscape of prostate biopsy (PB) is evolving with changes in procedures and techniques. Moreover, antibiotic resistance is increasing and influences the efficacy of pre-biopsy prophylactic regimens. Therefore, increasing antibiotic resistance may impact on clinical care, which probably results in differences between hospitals. The objective of our study is to determine the (variability in) current practices of PB in the Netherlands and to gain insight into Dutch urologists' perceptions of fluoroquinolone resistance and biopsy related infections.
An online questionnaire was prepared using SurveyMonkey® platform and distributed to all 420 members of the Dutch Association of Urology, who work in 81 Dutch hospitals. Information about PB techniques and periprocedural antimicrobial prophylaxis was collected. Urologists' perceptions regarding pre-biopsy antibiotic prophylaxis in an era of antibiotic resistance was assessed. Descriptive statistical analysis was performed.
One hundred sixty-one responses (38.3%) were analyzed representing 65 (80.3%) of all Dutch hospitals performing PB. Transrectal ultrasound guided prostate biopsy (TRUSPB) was performed in 64 (98.5%) hospitals. 43.1% of the hospitals (also) used other image-guided biopsy techniques. Twenty-three different empirical prophylactic regimens were reported among the hospitals. Ciprofloxacin was most commonly prescribed (84.4%). The duration ranged from one pre-biopsy dose (59.4%) to 5 days extended prophylaxis. 25.2% of the urologists experienced ciprofloxacin resistance as a current problem in the prevention of biopsy related infections and 73.6% as a future problem.
There is a wide variation in practice patterns among Dutch urologists. TRUSPB is the most commonly used biopsy technique, but other image-guided biopsy techniques are increasingly used. Antimicrobial prophylaxis is not standardized and prolonged prophylaxis is common. The wide variation in practice patterns and lack of standardization underlines the need for evidence-based recommendations to guide urologists in choosing appropriate antimicrobial prophylaxis for PB in the context of increasing antibiotic resistance.
前列腺活检（PB）的临床情况正在随着程序和技术的变化而发展。此外，抗生素耐药性正在增加，并影响了活检前预防性方案的疗效。因此，抗生素耐药性的增加可能会对临床护理产生影响，这可能导致医院之间存在差异。我们研究的目的是确定荷兰 PB 的当前实践情况，并深入了解荷兰泌尿科医生对抗生素耐药性和活检相关感染的看法。
使用 SurveyMonkey®平台编写了一份在线问卷，并分发给在 81 家荷兰医院工作的荷兰泌尿科协会的 420 名成员。收集了关于 PB 技术和围手术期抗菌预防的信息。评估了泌尿科医生在抗生素耐药性时代对活检前抗生素预防的看法。进行了描述性统计分析。
分析了 161 份回复（38.3%），代表了进行 PB 的 65 家（80.3%）荷兰医院中的 65 家。64 家（98.5%）医院进行了经直肠超声引导前列腺活检（TRUSPB）。43.1%的医院（也）使用了其他影像引导活检技术。报告的医院之间存在 23 种不同的经验性预防方案。最常开的处方是环丙沙星（84.4%）。疗程从单次活检前剂量（59.4%）到 5 天的延长预防。25.2%的泌尿科医生认为环丙沙星耐药性是预防活检相关感染的当前问题，73.6%认为是未来问题。
荷兰泌尿科医生的实践模式存在很大差异。TRUSPB 是最常用的活检技术，但其他影像引导活检技术的使用也在增加。抗菌预防措施没有标准化，延长预防措施很常见。实践模式的广泛差异和缺乏标准化突出表明，需要基于证据的建议来指导泌尿科医生在抗生素耐药性增加的情况下为 PB 选择适当的抗菌预防措施。
