Örtegren Joakim, Wimmerstedt Anna, Åberg Daniel, Janson Håkan, Kjölhede Henrik, Kahlmeter Gunnar, Bratt Ola
Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Section of Urology, Department of Surgery, Region Kronoberg, Växjö, Sweden.
Eur Urol Open Sci. 2022 Dec 26;48:54-59. doi: 10.1016/j.euros.2022.11.024. eCollection 2023 Feb.
Infectious complications after a transrectal prostate biopsy may be severe. In Sweden, a routine culture prior to all prostate biopsies was introduced to enable targeted antimicrobial prophylaxis and reduce postbiopsy infections.
To investigate whether a clinical routine with a urine culture prior to a prostate biopsy and targeted prophylactic antibiotic therapy reduces postbiopsy infections.
In 2015, a site-specific antimicrobial stewardship programme with a urine culture prior to a prostate biopsy was initiated in Region Kronoberg. To evaluate this routine, we designed a population-based register study including all men who had an outpatient prostate biopsy in 2015-2019 and a control period including all men who had a biopsy in 2010-2014, when a urinary culture was obtained only on clinical suspicion.
The primary outcome was infectious complications within 10 d and the secondary outcome was a change in antibiotic prophylactic treatment. An infectious complication was defined as prescription of antibiotics for urinary tract infections or admission to hospital for urinary tract infections or sepsis after a biopsy.
The urine culture period included 2971 prostate biopsy procedures, of which 2684 (90%) were preceded by a urine culture The control period included 2818 procedures, of which 135 (4.8%) were preceded by a urine culture. Infectious complications were slightly more common during the urine culture period (5.0%) than during the control period (4.3%, = 0.17), as was inpatient care for infections (3.5% vs 2.2%, = 0.002). The routine identified 5.4% men with asymptomatic bacteriuria. Despite targeted antibiotic treatment (1.5% received a nonfluoroquinolone treatment), the rate of infectious complications (6.3%) was similar to that in the control period.
Prebiopsy urine culture did not lead to fewer postbiopsy infections. Other measures are needed to reduce infectious complications after a prostate biopsy.
In this report, we evaluated a routine with urine culture prior to a transrectal prostate biopsy and found that it did not lead to fewer infectious complications.
经直肠前列腺穿刺活检后的感染并发症可能很严重。在瑞典，所有前列腺穿刺活检前引入常规培养，以实现针对性抗菌预防并减少活检后感染。
研究前列腺穿刺活检前进行尿培养及针对性预防性抗生素治疗的临床常规做法是否能减少活检后感染。
设计、地点和参与者：2015年，克鲁努贝里地区启动了一项针对特定地点的抗菌管理计划，在前列腺穿刺活检前进行尿培养。为评估该常规做法，我们设计了一项基于人群的登记研究，纳入2015 - 2019年所有接受门诊前列腺穿刺活检的男性，以及一个对照期，纳入2010 - 2014年所有接受活检的男性，当时仅在临床怀疑时进行尿培养。
主要结局是10天内的感染并发症，次要结局是抗生素预防性治疗的变化。感染并发症定义为活检后因尿路感染开具抗生素处方或因尿路感染或败血症住院。
尿培养期包括2971例前列腺穿刺活检手术，其中2684例（90%）在活检前进行了尿培养。对照期包括2818例手术，其中135例（4.8%）在活检前进行了尿培养。尿培养期的感染并发症（5.0%）略比对照期（4.3%，P = 0.17）更常见，感染的住院治疗情况也是如此（3.5%对2.2%，P = 0.002）。该常规做法识别出5.4%的无症状菌尿男性。尽管进行了针对性抗生素治疗（1.5%接受了非氟喹诺酮类治疗），感染并发症发生率（6.3%）与对照期相似。
活检前尿培养并未减少活检后感染。需要采取其他措施来减少前列腺穿刺活检后的感染并发症。
在本报告中，我们评估了经直肠前列腺穿刺活检前进行尿培养的常规做法，发现其并未减少感染并发症。
