Averch Timothy, Tessier Christopher, Clemens J Quentin, Franks Michael, Gonzalez Christopher, Jones J Stephen, Kapoor Deepak A, Lightner Deborah J, Liss Michael, Montie James, Watson Richard A, Wolf J Stuart
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Urol Pract. 2015 Jul;2(4):172-180. doi: 10.1016/j.urpr.2014.10.011. Epub 2015 Apr 20.
The AUA Quality Improvement Summit is a continuing AUA effort to provide education around issues related to quality improvement and patient safety. Due to the rapidly increasing rates of hospitalization following prostate needle biopsy, Infectious Complications of Transrectal Prostate Needle Biopsy was selected as the inaugural topic.
The information is largely unpublished data provided by the presenting physicians. Infection rates are predominantly self-reported with protocols specified by the physicians' home institutions. Beyond the identified speakers, the open forum of this summit allowed for input from a majority of the participants.
Current hospitalization rates for transrectal prostate needle biopsy infections vary widely from 0.5% to 6%. Antibiotic resistance of coliform organisms appears to be a major risk of these infectious complications. Prophylactic protocols also vary widely among the represented institutions. Antibiotic resistance profiles showed extreme regional variation and, as such, a prophylactic antibiotic protocol should be based on the current local antibiogram in order to reduce infection rates. Opinions vary in relation to the specific antibiotics appropriate for an augmented antibiotic prophylaxis, in the use of rectal swab and prebiopsy enema, and povidone-iodine preparation of the rectal vault. Standardization of the transrectal antibiotic prophylaxis across practices has been proven to reduce the infectious complications rates.
Urologists should monitor the prostate biopsy infection rates of the practice and consult the current local antibiogram. Physicians should query patients to assess whether they are at high risk for resistant organisms. If so, prophylactic protocols might be intensified.
美国泌尿外科学会质量改进峰会是该学会持续开展的一项活动，旨在围绕质量改进和患者安全相关问题提供教育。由于前列腺穿刺活检后住院率迅速上升，经直肠前列腺穿刺活检的感染并发症被选为首个主题。
这些信息主要是由发言医生提供的未发表数据。感染率主要是医生所在机构规定的自我报告数据。除了已确定的发言者外，本次峰会的开放论坛还允许大多数参与者发表意见。
目前经直肠前列腺穿刺活检感染的住院率差异很大，从0.5%到6%不等。大肠菌属的抗生素耐药性似乎是这些感染并发症的主要风险。各代表机构的预防方案也差异很大。抗生素耐药性情况显示出极大的地区差异，因此，预防性抗生素方案应基于当前当地的抗菌谱，以降低感染率。对于适用于强化抗生素预防的具体抗生素、直肠拭子和活检前灌肠的使用以及直肠穹窿的聚维酮碘制剂，各方意见不一。已证明跨实践标准化经直肠抗生素预防可降低感染并发症发生率。
泌尿外科医生应监测所在机构的前列腺活检感染率，并参考当前当地的抗菌谱。医生应询问患者，评估他们是否有感染耐药菌的高风险。如果是这样，可能需要强化预防方案。
