Farrell James, Salter Carolyn, Cullen Jennifer, Mordkin Robert, Joel Andrew
Urology Service, Walter Reed National Military Medical Center, Bethesda, Maryland.
Center for Prostate Disease Research, Rockville, Maryland.
Urol Pract. 2015 Jul;2(4):166-171. doi: 10.1016/j.urpr.2014.10.012. Epub 2015 Apr 2.
The rate of post-prostate biopsy infection is increasing. We noted this trend in our practice and began using prebiopsy rectal swab cultures to direct antibiotic prophylaxis. Clinical investigation has shown that culture directed antibiotic prophylaxis is effective. We report our methods and results as validation that culture directed antibiotic prophylaxis works in the community.
We retrospectively reviewed the charts of 686 consecutive patients who underwent transrectal prostate biopsy from March 2010 to April 2013. The electronic medical record was queried for the antibiotic prophylaxis used, rectal swab culture, post-biopsy infection, culture data and post-biopsy hospitalization if applicable. Prebiopsy rectal swab was incorporated into our practice in May 2012. Each patient received 3 days of fluoroquinolone prophylaxis or culture directed antibiotic prophylaxis. If antibiotic resistance to standard fluoroquinolone prophylaxis was identified, antibiotic prophylaxis was adjusted appropriately.
Of 543 patients who received standard fluoroquinolone prophylaxis 17 (3.1%) had infectious complications. Eight patients were hospitalized for post-biopsy sepsis and 4 received outpatient treatment for urinary tract infection. A total of 143 patients underwent prebiopsy rectal swabs and received culture directed antibiotic prophylaxis. Compared to standard antibiotic prophylaxis no patient treated with culture directed antibiotic prophylaxis after a rectal swab had infectious complications (p = 0.03). However, 19.5% of the patients in this group had resistant bacteria requiring alternative antibiotic prophylaxis.
A prebiopsy rectal swab to direct antibiotic prophylaxis decreased post-biopsy infectious complications in the community setting. The strategy is simple and it improves patient safety.
前列腺穿刺活检后感染率呈上升趋势。我们在临床实践中注意到了这一趋势，并开始使用穿刺前直肠拭子培养来指导抗生素预防。临床研究表明，根据培养结果进行抗生素预防是有效的。我们报告我们的方法和结果，以验证根据培养结果进行抗生素预防在社区中是有效的。
我们回顾性分析了2010年3月至2013年4月期间连续686例行经直肠前列腺穿刺活检患者的病历。查询电子病历中使用的抗生素预防措施、直肠拭子培养结果、穿刺活检后感染情况、培养数据以及必要时的穿刺活检后住院情况。2012年5月，穿刺前直肠拭子检查纳入我们的临床实践。每位患者接受3天的氟喹诺酮预防或根据培养结果进行抗生素预防。如果确定对标准氟喹诺酮预防存在抗生素耐药性，则适当调整抗生素预防措施。
在543例接受标准氟喹诺酮预防的患者中，17例（3.1%）出现感染并发症。8例患者因穿刺活检后败血症住院，4例接受了尿路感染的门诊治疗。共有143例患者进行了穿刺前直肠拭子检查，并接受了根据培养结果进行的抗生素预防。与标准抗生素预防相比，直肠拭子检查后接受根据培养结果进行抗生素预防的患者无一例出现感染并发症（p = 0.03）。然而，该组中有19.5%的患者存在耐药菌，需要更换抗生素进行预防。
穿刺前直肠拭子检查指导抗生素预防可降低社区环境中穿刺活检后的感染并发症。该策略简单，可提高患者安全性。
