Al-Mitwalli Abdullah, Kyriazis Grigorios, El-Taji Omar, Chandra Elizabeth, Deborah Wearmouth, Burns Phillipa, Fady Youssef, Simms Matthew, Nicholas Smith
Urology Department, St James University Hospital, Leeds, UK.
Urology Department, Castle Hill Hospital, Hull, UK.
Curr Urol. 2021 Jun;15(2):115-118. doi: 10.1097/CU9.0000000000000013. Epub 2021 Apr 26.
Urosepsis is a recognized complication of transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Pre-biopsy rectal swabs have been used to identify patients with microorganisms in the rectal flora resistant to the conventionally used empirical prophylaxis. The transperineal route of biopsy (TP-Bx) has a lower complication risk but comes at an increased cost.
Retrospective cohort study including patients undergoing prostate biopsies between October/2015 and April/2018. The intervention cohort, a rectal swab was performed, the result of which dictated the biopsy route; TRUS-Bx against TP-Bx. TP-Bx for patients with fluoroquinolone resistance or extended-spectrum β-lactamase. The control cohort underwent TRUS without a rectal swab receiving empirical antibiotics-oral ciprofloxacin and intravenous gentamicin.
Total 1000 patients were included in which 500 underwent a swab, 14 (2.8%) developed post-TRUS biopsy infective complications with 3 having positive bacteremia (0.6%); 500 had no swab, 47 (9.4%) developed post-TRUS biopsy infective complications with 22 (4.4%, < 0.05) having positive bacteremia. Three patients (0.6%) of patients who underwent swab developed urinary tract infection symptoms whilst 12 (2.4%) had urinary tract infection in the control group. In those patients that underwent a swab, 14 required hospitalization with mean length of stay of 2.5 days versus 43 patients of the control with 3.6 days. Cost analysis concluded savings of this strategy was £18,711.
We have demonstrated a protocol that reserves template biopsies for higher risk patients and can significantly reduce sepsis and other infectious complication rates whilst also proving to be a cost-efficient strategy. We recommend that units not utilizing rectal swabs to uncover the fluoroquinolone resistance rate by introducing them. We advocate units that already utilize rectal swabs, to introduce transperineal biopsy for their higher risk patients.
尿脓毒症是经直肠超声引导下前列腺穿刺活检（TRUS - Bx）公认的并发症。活检前直肠拭子已用于识别直肠菌群中对常规使用的经验性预防措施耐药的微生物患者。经会阴途径活检（TP - Bx）并发症风险较低，但成本较高。
回顾性队列研究，纳入2015年10月至2018年4月期间接受前列腺活检的患者。干预队列进行直肠拭子检查，其结果决定活检途径；对氟喹诺酮耐药或产超广谱β - 内酰胺酶的患者采用TP - Bx，对其他患者采用TRUS - Bx。对照队列在未进行直肠拭子检查的情况下接受TRUS，给予经验性抗生素——口服环丙沙星和静脉注射庆大霉素。
共纳入1000例患者，其中500例进行了拭子检查，14例（2.8%）发生TRUS活检后感染性并发症，3例血培养阳性（0.6%）；500例未进行拭子检查，47例（9.4%）发生TRUS活检后感染性并发症，22例（4.4%，<0.05）血培养阳性。进行拭子检查的患者中有3例（0.6%）出现尿路感染症状，而对照组中有12例（2.4%）出现尿路感染。在进行拭子检查的患者中，14例需要住院，平均住院时间为2.5天，而对照组有43例，平均住院时间为3.6天。成本分析得出该策略节省了18,711英镑。
我们展示了一种方案，该方案为高风险患者保留模板活检，可显著降低脓毒症和其他感染并发症发生率，同时证明是一种具有成本效益的策略。我们建议各单位通过引入直肠拭子检查来了解氟喹诺酮耐药率。我们主张已经使用直肠拭子检查的单位，为其高风险患者引入经会阴活检。
