Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, 901 87, Sweden.
Department of Urology, Sundsvall Hospital, Sundsvall, 851 86, Sweden.
F1000Res. 2020 Jan 28;9:58. doi: 10.12688/f1000research.19260.1. eCollection 2020.
The risk of infection after transrectal ultrasound (TRUS)-guided prostate biopsies is increasing. The aim of the study was to assess the use of antibiotic prophylaxis for prostate biopsy in Sweden. All public and private urology clinics reporting to the National Prostate Cancer Register of Sweden received a survey on TRUS-biopsy prophylaxis. Of the 84 clinics surveyed, 76 replied (90%). If no risk factors for infection were present, a single dose of ciprofloxacin 750 mg was used by 50 clinics (66%). Multiple doses of ciprofloxacin 500 or 750 mg (n=14; 18%) or a single dose of trimethoprim-sulfamethoxazole 160/800 mg (n=7; 9%) were other common prophylaxes. Most clinics gave the prophylaxes immediately before the biopsy (n=41; 54%). Urine dipstick was used by 30 clinics (39%) and rectal enema by six (8%). In patients with high risk of infection, the survey mirrors a large variety of regiments used. The preference to use a single dose of ciprofloxacin 750 mg is in accordance with the Swedish national guidelines for patients with a low risk of infection. Better compliance to the guideline recommendation to use a urine dipstick would probably increase the number of patients classified as having an increased risk of infection. Being classified as a high-risk patient should lead to an extended duration of antibiotic prophylaxis, however, the variety of regimens used in the high-risk group reflects an inability to treat these patients in a standardized fashion and also highlights a need for more clear-cut guidelines. Pre-biopsy identification of high-risk patients is an important issue to tackle for the urologic clinics in order to reduce the number of infections.
经直肠超声（TRUS）引导前列腺活检后感染的风险正在增加。本研究旨在评估在瑞典使用抗生素预防前列腺活检。所有向瑞典国家前列腺癌登记处报告的公立和私立泌尿科诊所都收到了一份关于 TRUS 活检预防的调查。在接受调查的 84 家诊所中，有 76 家（90%）做出了回应。如果不存在感染的危险因素，50 家诊所（66%）使用单剂量环丙沙星 750mg。其他常见的预防方案是使用环丙沙星 500 或 750mg 多次剂量（n=14；18%）或单次剂量复方磺胺甲噁唑 160/800mg（n=7；9%）。大多数诊所（n=41；54%）在活检前立即给予预防措施。30 家诊所（39%）使用尿液试纸，6 家（8%）使用直肠灌肠。在感染风险高的患者中，调查反映出使用了各种不同的方案。选择使用单剂量环丙沙星 750mg 与瑞典国家指南中针对低感染风险患者的建议一致。如果更严格地遵守指南建议使用尿液试纸，可能会增加被归类为感染风险增加的患者数量。被归类为高风险患者应该导致抗生素预防时间延长，然而，高风险组中使用的各种方案反映出无法以标准化的方式治疗这些患者，也凸显出需要更明确的指南。在进行活检之前识别高风险患者是泌尿科诊所需要解决的一个重要问题，以减少感染的数量。
