Albers Patrick, Bennett Jacob, Evans Moira, St Martin Ella, Broomfield Stacey, Martín Anaïs Medina, Fung Christopher, Kinnaird Adam
Division of Urology, Department of Surgery, University of Alberta, AB, Canada.
Alberta Prostate Cancer Research Initiative (APCaRI), Edmonton, AB, Canada.
Can Urol Assoc J. 2024 Mar;18(3):E80-E83. doi: 10.5489/cuaj.8532.
Infectious complications after transrectal prostate biopsy have been increasing, driven in large part, by rates of antibiotic resistance to conventional prophylaxis, such as ciprofloxacin. This study was designed to compare conventional antibiotic prophylaxis (oral ciprofloxacin) with ciprofloxacin and fosfomycin combination therapy prior to biopsy.
This was a retrospective study looking at men between September 2021 and April 2023, who underwent transrectal prostate biopsy at several institutions in Alberta. The primary outcome was infectious complications within 30 days of prostate biopsy. Secondary outcomes included Clostridium difficile infections, urinary retention, gross hematuria, diarrhea, emergency room (ER ) visits, hospital admissions, and intensive care unit (ICU) admissions. Data was collected on resistance patterns and pathogens isolated in culture.
During the study period, 2168 men underwent transrectal prostate biopsy. A total of 1216 men received ciprofloxacin alone and 877 received fosfomycin and ciprofloxacin. Infectious complications were significantly higher in the ciprofloxacin alone group (5.8% vs. 0.5%, p<0.0001). Thirty-day complications (7.2% vs. 2.1%, p<0.0001), 30-day ER visits (7.1% vs. 1.8%, p<0.0001), and 30-day hospitalizations (2.7% vs. 0.7%, p<0.001) were all higher in the ciprofloxacin alone group. The most isolated pathogen was E. coli in 54/60 (90%). Ciprofloxacin resistance in the isolated pathogens was high, with 52/60 (87%) showing resistance to ciprofloxacin and 51/54 (94%) E. coli strains resistant. No difference was seen in retention, C. difficile infections, bleeding, or diarrhea.
The addition of fosfomycin for antibiotic prophylaxis prior to transrectal prostate biopsy was associated with significant improvement in infectious complications and healthcare utilization.
经直肠前列腺活检后的感染性并发症一直在增加，这在很大程度上是由对环丙沙星等传统预防性抗生素的耐药率上升所驱动的。本研究旨在比较活检前传统抗生素预防（口服环丙沙星）与环丙沙星和磷霉素联合治疗的效果。
这是一项回顾性研究，观察了2021年9月至2023年4月期间在艾伯塔省多家机构接受经直肠前列腺活检的男性。主要结局是前列腺活检后30天内的感染性并发症。次要结局包括艰难梭菌感染、尿潴留、肉眼血尿、腹泻、急诊就诊、住院和重症监护病房（ICU）入院。收集了培养中分离出的耐药模式和病原体的数据。
在研究期间，2168名男性接受了经直肠前列腺活检。共有1216名男性仅接受环丙沙星治疗，877名男性接受磷霉素和环丙沙星治疗。仅使用环丙沙星组的感染性并发症显著更高（5.8%对0.5%，p<0.0001）。仅使用环丙沙星组的30天并发症（7.2%对2.1%，p<0.0001）、30天急诊就诊（7.1%对1.8%，p<0.0001）和30天住院率（2.7%对0.7%）均更高。最常分离出的病原体是大肠杆菌，共54/60（90%）。分离出的病原体对环丙沙星的耐药性很高，52/60（87%）对环丙沙星耐药，51/54（94%）的大肠杆菌菌株耐药。在尿潴留、艰难梭菌感染、出血或腹泻方面未观察到差异。
经直肠前列腺活检前添加磷霉素进行抗生素预防与感染性并发症和医疗资源利用的显著改善相关。
