Cardoso Andreia, Ribeiro Jorge, Araújo Rafael, Torres João Pimentel, Mota Paulo
Department of Urology, Hospital de Braga, Braga, Portugal.
University of Minho, School of Medicine, Braga, Portugal.
Urol Res Pract. 2023 Jul;49(4):259-265. doi: 10.5152/tud.2023.23030.
Due to fluoroquinolone resistances worldwide, valid alternatives for anti- biotic prophylaxis for transrectal ultrasound-guided prostate biopsy are needed, thus, we aimed to evaluate the efficacy, safety, and tolerability of prophylactic fosfomycin versus other oral prolonged antibiotic regimens, in preventing complications after transrectal ultrasound-guided prostate biopsy.
In this prospective study, patients submitted to transrectal ultrasound- guided prostate biopsy were divided into 2 groups according to the prophylactic antibiotic scheme performed: "short" (2 fosfomycin doses) versus "long" (antibiotic ≥ 8 days). One week and 1 month after transrectal ultrasound-guided prostate biopsy, we assessed complications' occurrence (lower urinary tract symptoms, fever, sepsis, hemorrhage) and adverse drug reactions.
We included 244 patients (fosfomycin n=178, "long" antibiotic n=66). The only significant difference between groups was higher lower urinary tract symptom incidence 1 month after transrectal ultrasound-guided prostate biopsy in fosfomy- cin patients (16.85% vs. 6.06%, P=.031). However, after 1 week, lower urinary tract symptoms were tendentially frequenter on "long" antibiotic group (31.81% vs. 25.84%, P = .059). Infectious and hemorrhagic complications rate, adverse drug reactions, and recurrence to health services were similar between groups, and significantly decreased between the first week and first month.
Antibiotic prophylaxis seems to impact lower urinary tract symptoms after transrectal ultrasound-guided prostate biopsy. Fosfomycin may provide slightly better outcome on the immediate period, while "long" antibiotic courses lead to significantly less lower urinary tract symptoms 1 month post-transrectal ultrasound-guided pros- tate biopsy, perhaps by preventing incipient prostatitis phenomena. Future directed studies should clarify these findings. Still, it seems feasible to ally fosfomycin advan- tages with noninferior safety, efficacy, and tolerability, allowing to reserve "long" regimens to other contexts. This is especially relevant in centers where transperineal biopsies are still not possible.
鉴于全球范围内氟喹诺酮耐药性问题，经直肠超声引导下前列腺穿刺活检的抗生素预防需要有效的替代方案，因此，我们旨在评估预防性使用磷霉素与其他口服延长疗程抗生素方案在预防经直肠超声引导下前列腺穿刺活检后并发症方面的疗效、安全性和耐受性。
在这项前瞻性研究中，接受经直肠超声引导下前列腺穿刺活检的患者根据所采用的预防性抗生素方案分为两组：“短疗程”（2剂磷霉素）组和“长疗程”（抗生素使用≥8天）组。在经直肠超声引导下前列腺穿刺活检后1周和1个月，我们评估并发症的发生情况（下尿路症状、发热、败血症、出血）和药物不良反应。
我们纳入了244例患者（磷霉素组n = 178，“长疗程”抗生素组n = 66）。两组之间唯一的显著差异是，经直肠超声引导下前列腺穿刺活检后1个月，磷霉素组患者下尿路症状发生率较高（16.85%对6.06%，P = 0.031）。然而，1周后，“长疗程”抗生素组下尿路症状出现频率有更高的趋势（31.81%对25.84%，P = 0.059）。两组之间的感染和出血并发症发生率、药物不良反应以及再次就医情况相似，且在第一周和第一个月之间显著下降。
抗生素预防似乎会影响经直肠超声引导下前列腺穿刺活检后的下尿路症状。磷霉素在短期内可能提供稍好的结果，而“长疗程”抗生素方案在经直肠超声引导下前列腺穿刺活检后1个月导致的下尿路症状显著较少，这可能是通过预防初期前列腺炎现象实现的。未来有针对性的研究应阐明这些发现。尽管如此，将磷霉素的优势与非劣效的安全性、有效性和耐受性相结合似乎是可行的，从而可以将“长疗程”方案保留用于其他情况。这在仍无法进行经会阴穿刺活检的中心尤为重要。
