Tulone Gabriele, Giannone Sofia, Mannone Piero, Tognarelli Alessio, Di Vico Tommaso, Giaimo Rosa, Zucchi Alessandro, Rossanese Marta, Abrate Alberto, Pavan Nicola, Claps Francesco, Ficarra Vincenzo, Bartoletti Riccardo, Simonato Alchiede
Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy.
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy.
Antibiotics (Basel). 2022 Mar 20;11(3):415. doi: 10.3390/antibiotics11030415.
Our study aimed to compare the incidence of infective complications after transrectal ultrasound-guided prostate biopsy (TRUSBx) when adopting different antimicrobial prophylaxis regimens. A multi-institutional cohort of 1150 patients who underwent TRUSBx was retrospectively analyzed. Procedures were performed between 2017 and 2019 (before and after the EMA warning about the use of fluoroquinolones for the antibiotic prophylaxis of patient candidates to TRUSBx). The primary endpoint was the occurrence of infective complications, including sepsis and/or fever. The population was stratified according to the antibiotic prophylaxis adopted: fluoroquinolones (levofloxacin, ciprofloxacin, prulifloxacin), cephalosporins (cefixime, ceftriaxone) or trimethoprim/sulfamethoxazole. Univariable and multivariable binomial logistic regression models were used to assess the odds ratio (OR) with 95% confidence interval (CI) testing of the risk of infective complication after adjusting for each prebiopsy covariate. In total, 478 (41.6%) patients received fluoroquinolone-based prophylaxis. Among these, 443 (38.5%), 25 (2.2%) and 10 (0.9%) patients received levofloxacin prophylaxis, ciprofloxacin and prulifloxacin, respectively while 14.6% received cefixime, 20.7% received the comedication of ceftriaxone/fosfomycin and 23.1% received trimethoprim/sulfamethoxazole. The trimethoprim/sulfamethoxazole and fluoroquinolone regimens were significantly associated with a lower risk of infective complications (OR 0.15, 95% CI 0.03−0.48, p = 0.003 and OR 0.17, 95% CI 0.06−0.43, p < 0.001, respectively). The ceftriaxone/fosfomycin (OR 0.21, 95% CI 0.04−0.92, p = 0.04) and fluoroquinolone (OR 0.07, 95% CI 0.00−0.70, p = 0.048) prophylaxis were associated with a lower risk of infective sequelae. Fluoroquinolone-based prophylaxis was associated with a lower risk of infective complications after TRUSBx compared to other prophylaxis regimens although its clinical application was recently forbidden by European Medical Agency restrictions.
我们的研究旨在比较采用不同抗菌预防方案后经直肠超声引导下前列腺穿刺活检(TRUSBx)后感染性并发症的发生率。对1150例行TRUSBx的多机构队列患者进行了回顾性分析。手术于2017年至2019年期间进行(欧洲药品管理局(EMA)发布关于氟喹诺酮类药物用于TRUSBx候选患者抗生素预防的警告之前和之后)。主要终点是感染性并发症的发生,包括败血症和/或发热。根据采用的抗生素预防措施对人群进行分层:氟喹诺酮类(左氧氟沙星、环丙沙星、普卢利沙星)、头孢菌素类(头孢克肟、头孢曲松)或甲氧苄啶/磺胺甲恶唑。使用单变量和多变量二项式逻辑回归模型评估调整每个活检前协变量后感染性并发症风险的比值比(OR)及95%置信区间(CI)。共有478例(41.6%)患者接受基于氟喹诺酮类的预防。其中,分别有443例(38.5%)、25例(2.2%)和10例(0.9%)患者接受左氧氟沙星预防、环丙沙星和普卢利沙星预防,而14.6%的患者接受头孢克肟预防,20.7%的患者接受头孢曲松/磷霉素联合用药预防,23.1%的患者接受甲氧苄啶/磺胺甲恶唑预防。甲氧苄啶/磺胺甲恶唑和氟喹诺酮类方案与较低的感染性并发症风险显著相关(OR分别为0.15,95%CI为0.03 - 0.48,p = 0.003;OR为0.17,95%CI为0.06 - 0.43,p < 0.001)。头孢曲松/磷霉素(OR为0.21,95%CI为0.04 - 0.92,p = 0.04)和氟喹诺酮类(OR为0.07,95%CI为0.00 - 0.70,p = 0.048)预防与较低的感染后遗症风险相关。与其他预防方案相比,基于氟喹诺酮类的预防与TRUSBx后较低的感染性并发症风险相关,尽管其临床应用最近因欧洲药品管理局的限制而被禁止。