Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany,
Department of Urology and Pediatric Urology, University Hospital of Bonn, Bonn, Germany.
Urol Int. 2020;104(5-6):378-385. doi: 10.1159/000507123. Epub 2020 May 12.
Urinary tract infections (UTI) represent the most frequent complications after transrectal focal ablation of prostate cancer. Single-shot antibiotic prophylaxis for prevention has not yet been described.
In this cohort study of patients who received a high-intensity focused ultrasound (HIFU) ablation of prostate cancer within a registered prospective single-arm trial, we analyzed posttreatment UTI (≤30 days after HIFU) related to perioperative antibiotic management in an exploratory analysis: single-shot prophylaxis or targeted treatment for bacteriuria. Potential risk factors associated with UTI were evaluated by uni- and multivariate regression analyses.
In total, 55 patients were eligible for analysis. Of these, 76.4% received antibiotic single-shot prophylaxis. UTI occurred in 10.7% of all patients, 5.4% developed fever, 3.6% required hospitalization. An antibiotic single-shot prophylaxis helped to protect 90.5% of men from infectious complications. Estimated effects indicate that a longer posttreatment catheterization (OR 3.38, 95% CI 0.47-27.08) and larger ablation volume (OR 4.85, 95% CI 0.61-107.49) might be associated with the highest risk for UTI after treatment.
Single-shot antibiotic prophylaxis compared to a targeted antibiotic treatment showed a similar effectivity to prevent patients from infectious complications and should be considered as an element of antibiotic stewardship. Further research on risk factors and antibiotic strategies is required.
经直肠前列腺癌局部聚焦消融术后，尿路感染（UTI）是最常见的并发症。目前还没有描述单次预防性使用抗生素来预防 UTI。
在这项针对接受高强度聚焦超声（HIFU）消融前列腺癌的患者的队列研究中，我们在一项注册的前瞻性单臂试验中对治疗后（HIFU 后 30 天内）的 UTI 进行了分析，对围手术期抗生素管理与 UTI 的相关性进行了探索性分析：单次预防用药或针对菌尿的靶向治疗。通过单变量和多变量回归分析评估与 UTI 相关的潜在危险因素。
共有 55 例患者符合分析条件，其中 76.4%接受了抗生素单次预防用药。所有患者中有 10.7%发生 UTI，5.4%发热，3.6%需要住院治疗。抗生素单次预防用药有助于保护 90.5%的男性免受感染性并发症的影响。估计结果表明，治疗后较长的导管留置时间（OR 3.38，95%CI 0.47-27.08）和较大的消融体积（OR 4.85，95%CI 0.61-107.49）可能与 UTI 的风险最高相关。
与靶向抗生素治疗相比，单次预防性使用抗生素在预防患者感染并发症方面具有相似的效果，应被视为抗生素管理的一个要素。需要进一步研究危险因素和抗生素策略。
