Newman Thomas Hedley, Stroman Luke, Hadjipavlou Marios, Haque Arman, Rusere Jonah, Chan Kimberley, Ioannides Demetris, Di Benedetto Antonina, Pinczes Tibor, Popert Rick, Hammadeh Mohamed Y
Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK.
Guy's and St Thomas' NHS trust, Guy's Hospital, Great Maze Pond, London, UK.
Prostate Cancer Prostatic Dis. 2022 Feb;25(2):283-287. doi: 10.1038/s41391-021-00438-w. Epub 2021 Aug 19.
Transrectal prostate biopsy (TRUSBx) holds a risk of prostate biopsy related sepsis. We discuss our step-wise strategies aiming to reduce this risk, including targeted antimicrobials and switching to a freehand transperineal approach (FHTPBx).
This longitudinal cohort study included three groups. Group A underwent TRUSBx with empirical augmented antimicrobial prophylaxis; Group B underwent TRUSBx with targeted antimicrobial prophylaxis, based on rectal-swab cultures/sensitivity; Group C underwent FHTPBx with empirical antimicrobial prophylaxis. Post biopsy sepsis, defined according to the surviving sepsis campaign and confirmed with blood or urinary cultures, were determined and rates between groups were analysed using fisher's exact test.
Of all 1501 patients, 23 developed post biopsy sepsis; Group A (12/609, 2.0%), B (9/403, 2.2%), C (2/489, 0.4%). Targeted antimicrobials did not reduce the risk of post biopsy sepsis following TRUSBx (A vs B, 2.0% vs 2.2%; p = 0.82). Patients with antimicrobial-resistant rectal flora had an increased post biopsy sepsis rate following TRUSBx despite targeted antimicrobials (9.1% vs 1.1%, p = 0.003). Switching to FHTPBx reduced the risk of developing post biopsy sepsis (A vs C, 2% vs 0.4%, p = 0.03; B vs C, 2.2% vs 0.4%, p = 0.03).
Targeted antimicrobials based on rectal swab culture failed to reduce the overall risk of post biopsy sepsis, while FHTPBx nearly eliminated this risk. We recommend the use of transperineal prostate biopsies for all patients as the most effective method to reduce the risk of sepsis.
经直肠前列腺活检（TRUSBx）存在前列腺活检相关脓毒症的风险。我们讨论旨在降低该风险的逐步策略，包括针对性抗菌药物以及改用徒手经会阴途径（FHTPBx）。
这项纵向队列研究包括三组。A组接受TRUSBx并进行经验性强化抗菌预防；B组接受TRUSBx并根据直肠拭子培养/药敏结果进行针对性抗菌预防；C组接受FHTPBx并进行经验性抗菌预防。根据脓毒症存活运动定义并经血液或尿液培养确诊的活检后脓毒症情况被确定，并使用Fisher精确检验分析组间发生率。
在所有1501例患者中，23例发生活检后脓毒症；A组（12/609，2.0%），B组（9/403，2.2%），C组（2/489，0.4%）。针对性抗菌药物并未降低TRUSBx后活检后脓毒症的风险（A组与B组，2.0%对2.2%；p = 0.82）。尽管使用了针对性抗菌药物，但直肠菌群耐药的患者在TRUSBx后活检后脓毒症发生率增加（9.1%对1.1%，p = 0.003）。改用FHTPBx降低了发生活检后脓毒症的风险（A组与C组，2%对0.4%，p = 0.03；B组与C组，2.2%对0.4%，p = 0.03）。
基于直肠拭子培养的针对性抗菌药物未能降低活检后脓毒症的总体风险，而FHTPBx几乎消除了该风险。我们建议对所有患者采用经会阴前列腺活检作为降低脓毒症风险的最有效方法。
