Rafiq Muhammad, Gabriel Melissa, Reddy Ultsav, Rochester Mark, Farag Fawzy
Department of Urology, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
Department of Urology, East Suffolk and North Essex Foundation Trust, Ipswich, United Kingdom.
Cent European J Urol. 2022;75(2):205-208. doi: 10.5173/ceju.2022.0229. Epub 2022 Apr 23.
Urosepsis is a significant risk associated with prostate biopsy. Resistance of microorganisms to antibiotics is a challenging issue for clinicians in everyday practice. In the current study, we investigated the rates of sepsis and hospital admissions following transperineal (TP) prostate biopsies using a single dose of gentamicin.
Data for consecutive patients who underwent TP prostate biopsies (March 2019-March 2020) were included. Patients received a single-dose of prophylactic gentamicin 120 mg IV and had skin preparation with antiseptic povidone-iodine or chlorhexidine solution prior to the procedure. Patient's electronic records were reviewed for rates of sepsis and readmission to hospital within 7 days following TP prostate biopsy.
A total of 365 consecutive patients were included in the study. After exclusion of non-eligible patients, 280 patients were included in final analysis. The median age was 67 years (32-83), the median prostate-specific antigen (PSA) level was 8.5 ng/ml (0.2-58), and the median prostate size was 44 cc (10-188). Approximately 58% of patients had one or more comorbidities in the form of diabetes mellitus (DM), hypertension, asthma, chronic kidney disease, or ischemic heart disease. Adenocarcinoma was found in 71.7% of patients. None of the 280 patients developed sepsis. Urinary tract infection (UTI) occurred in 2.8% of patients with E.coli, none of them required hospital readmission.
Our single centre experience showed a 0% sepsis rate after TP prostate biopsy with single prophylactic dose of gentamicin. Future randomized controlled trials (RCTs) should explore the possibility of performing these procedures without antibiotic prophylaxis in order to reduce the unnecessary use of antibiotics.
尿脓毒症是前列腺活检相关的一项重大风险。微生物对抗生素的耐药性是临床医生日常实践中面临的一个具有挑战性的问题。在本研究中，我们调查了使用单剂量庆大霉素进行经会阴（TP）前列腺活检后的脓毒症发生率和住院率。
纳入2019年3月至2020年3月连续接受TP前列腺活检的患者数据。患者静脉注射单剂量预防性庆大霉素120mg，并在手术前用碘伏或氯己定溶液进行皮肤准备。回顾患者的电子记录，以了解TP前列腺活检后7天内的脓毒症发生率和再次入院率。
本研究共纳入365例连续患者。排除不符合条件的患者后，280例患者纳入最终分析。中位年龄为67岁（32 - 83岁），中位前列腺特异性抗原（PSA）水平为8.5ng/ml（0.2 - 58），中位前列腺体积为44cc（10 - 188）。约58%的患者有一种或多种合并症，形式为糖尿病（DM）、高血压、哮喘、慢性肾脏病或缺血性心脏病。71.7%的患者发现腺癌。280例患者中无一例发生脓毒症。2.8%的患者发生大肠杆菌引起的尿路感染，其中无一例需要再次住院。
我们的单中心经验显示，单剂量预防性庆大霉素用于TP前列腺活检后脓毒症发生率为0%。未来的随机对照试验（RCT）应探索在不进行抗生素预防的情况下进行这些手术的可能性，以减少抗生素的不必要使用。
