Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.
Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
Eur Urol Focus. 2021 Sep;7(5):980-986. doi: 10.1016/j.euf.2020.11.006. Epub 2020 Dec 24.
After recommended restriction of the use of fluoroquinolones, the optimal antibiotic prophylaxis for transrectal prostate biopsy is still under debate.
To test the effectiveness of cefpodoxime as oral antibiotic prophylaxis for transrectal prostate biopsies and the complication rates relative to fluoroquinolones.
DESIGN, SETTING, AND PARTICIPANTS: Antibiotic prophylaxis for transrectal prostate biopsies at the Department of Urology at University Hospital Frankfurt was fluoroquinolones for 342 consecutive patients in January 2018 and December 2019 and cefpodoxime for 100 patients from January 2020 to July 2020. Data were prospectively evaluated and retrospectively analyzed. Patients were followed up according to clinical routine at 6 wk after biopsy at the earliest. Patients without follow-up (n = 98) and those receiving antibiotic prophylaxis other than cefpodoxime or fluoroquinolones (n = 15) were excluded.
Use of cefpodoxime or fluoroquinolones as antibiotic prophylaxis for transrectal prostate biopsies.
Logistic regression models were used to predict biopsy-related complications according to antibiotic prophylaxis.
Of 442 patients, 100 (22.6%) received cefpodoxime as antibiotic prophylaxis. Patient baseline and biopsy characteristics were comparable between the cefpodoxime and fluoroquinolone groups. Moreover, there were no differences in the number of prior prostate biopsies or the proportions of systematic vs. fusion biopsies (p > 0.05). There were no differences between the groups in infectious complications such as epididymitis and prostatitis after biopsy. Infectious complication rates were very low, at 2.0% in the cefpodoxime and0.9%fluoroquinolone group. Moreover, there were no differences between the groups in patient-reported complications, such as gross hematuria occurring at more than 5 d after biopsy, hematospermia, or rectal bleeding. In multivariable analyses, after adjustment for patient and prostate biopsy characteristics, cefpodoxime was not associated with higher complication rates than fluoroquinolones (p > 0.05).
Complications after transrectal prostate biopsies are rare and cefpodoxime might be a sufficient choice as oral antibiotic prophylaxis and noninferior compared to fluoroquinolones.
Cefpodoxime might be a sufficient choice as an easily applicable oral antibiotic prophylaxis for transrectal prostate biopsy. The safety profile of cefpodoxime is comparable to the safety profile of fluoroquinolones.
在推荐限制氟喹诺酮类药物的使用后，经直肠前列腺活检的最佳抗生素预防措施仍存在争议。
测试头孢泊肟酯作为经直肠前列腺活检的口服抗生素预防的有效性，并与氟喹诺酮类药物相比，评估其相关并发症的发生率。
设计、地点和参与者：2018 年 1 月至 2019 年 12 月，法兰克福大学医院泌尿科对 342 例连续患者使用氟喹诺酮类药物进行经直肠前列腺活检，2020 年 1 月至 2020 年 7 月对 100 例患者使用头孢泊肟酯。数据进行了前瞻性评估和回顾性分析。根据临床常规，最早在活检后 6 周对患者进行随访。排除无随访的患者（n=98）和接受头孢泊肟酯或氟喹诺酮类药物以外的抗生素预防的患者（n=15）。
使用头孢泊肟酯或氟喹诺酮类药物作为经直肠前列腺活检的抗生素预防。
使用逻辑回归模型根据抗生素预防情况预测活检相关并发症。
在 442 例患者中，100 例（22.6%）接受头孢泊肟酯作为抗生素预防。头孢泊肟酯组和氟喹诺酮组患者的基线和活检特征相似。此外，既往前列腺活检次数或系统与融合活检的比例无差异（p>0.05）。两组之间的感染性并发症（如附睾炎和前列腺炎）无差异。感染性并发症发生率非常低，头孢泊肟酯组为 2.0%，氟喹诺酮组为 0.9%。此外，两组之间患者报告的并发症（如活检后超过 5 天出现肉眼血尿、血精或直肠出血）也无差异。多变量分析调整患者和前列腺活检特征后，头孢泊肟酯与氟喹诺酮类药物相比，并发症发生率无差异（p>0.05）。
经直肠前列腺活检后的并发症罕见，头孢泊肟酯可能是一种足够的选择，作为口服抗生素预防措施，且与氟喹诺酮类药物相比非劣效。
头孢泊肟酯可能是经直肠前列腺活检的一种易于应用的口服抗生素预防药物选择。头孢泊肟酯的安全性与氟喹诺酮类药物的安全性相当。
