Rothe Kathrin, Querbach Christiane, Busch Dirk H, Gschwend Jürgen E, Hauner Katharina
Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Technische Universität München Fakultät für Medizin, München, Deutschland.
Krankenhausapotheke Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, München, Deutschland.
Urologe A. 2022 Feb;61(2):160-166. doi: 10.1007/s00120-021-01618-1. Epub 2021 Aug 18.
Transrectal prostate biopsy (TRPB) is the gold standard for prostate cancer diagnosis and among the most common urological interventions. Short-term antibiotic prophylaxis (PAP) is recommended for TRPB. Fluoroquinolone-PAP as standard of care needs to be revaluated due to the restrictions on the use of fluoroquinolone antibiotics by the German Federal Institute for Drugs and Medical Devices.
The aim of the study was to analyze clinical practice of PAP for TRPB with focus on infectious complications and potential differences between fluoroquinolone-PAP and cotrimoxazole-PAP.
We performed a retrospective monocentric study of clinical and microbiological characteristics of patients with TRPB between 3 January 2019 and 28 January 2021.
A total of 508 men were included; median age was 68 years. In all, 55.9% of our cohort received cotrimoxazole-PAP and 40.0% fluoroquinolone-PAP. Postinterventional complications occurred in 5.5%, of those 50.0% were infectious complications. Complication rate did not differ between patients with fluoroquinolone-PAP and cotrimoxazole-PAP. Urinary cultures in case of postinterventional complications yielded pathogens with antimicrobial resistance against the used PAP substance indicating selection of resistant bacteria.
Cotrimoxazole-PAP for TRPB is not associated with an increase of infectious complications compared to fluoroquinolone-PAP. Cultures obtained prior to TRPB to identify antimicrobial resistance facilitate targeted PAP and therefore can reduce complications.
经直肠前列腺穿刺活检（TRPB）是前列腺癌诊断的金标准，也是最常见的泌尿外科干预措施之一。推荐对TRPB进行短期抗生素预防（PAP）。由于德国联邦药品和医疗器械研究所对氟喹诺酮类抗生素的使用限制，作为标准治疗方案的氟喹诺酮类PAP需要重新评估。
本研究旨在分析TRPB的PAP临床实践，重点关注感染性并发症以及氟喹诺酮类PAP和复方新诺明PAP之间的潜在差异。
我们对2019年1月3日至2021年1月28日期间接受TRPB的患者的临床和微生物学特征进行了一项回顾性单中心研究。
共纳入508名男性；中位年龄为68岁。总体而言，我们队列中的55.9%接受了复方新诺明PAP，40.0%接受了氟喹诺酮类PAP。介入后并发症发生率为5.5%，其中50.0%为感染性并发症。氟喹诺酮类PAP患者和复方新诺明PAP患者的并发症发生率无差异。介入后并发症患者的尿培养结果显示，病原体对所用的PAP物质具有抗菌耐药性，表明存在耐药菌的选择。
与氟喹诺酮类PAP相比，TRPB使用复方新诺明PAP不会增加感染性并发症。在TRPB前进行培养以确定抗菌耐药性有助于进行有针对性的PAP，从而可以减少并发症。
