A single dose of meropenem is superior to ciprofloxacin in preventing infections after transrectal ultrasound-guided prostate biopsies in the era of quinolone resistance

Samarinas, Michael; Dimitropoulos, Konstantinos; Zachos, Ioannis; Gravas, Stavros; Karatzas, Anastasios; Tzortzis, Vassilios

doi:10.1007/s00345-016-1800-z

Cited by 11 publications

(4 citation statements)

References 27 publications

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“… 41 , 48 , 50–53 However, several studies also do not recommend their routine use for prophylaxis because of the selection and spread of antibiotic resistance. 42 , 52 , 54 , 55 Given that 3.1% of TRUS-B patients developed post-biopsy complications, the option for no antibiotic prophylaxis pre-TRUS-B has also been proposed for our setting in the attempt to reduce the selective burden of FQ-resistant and ESBL-positive pathogens. The proponents suggest that rather, when patients develop post-TRUS-B infections, antibiotics like amikacin and meropenem—which showed wide coverage against the resistant pathogens in our study— may be used for treatment based on local antibiograms.…”

Section: Discussionmentioning

confidence: 99%

Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy

Obeng‐Nkrumah

Dayie

Addo

et al. 2022

JAC-Antimicrobial Resistance

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Background Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B) Objectives We investigated the relationship between carriage of FQ-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications. Methods From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors. Results Overall, 86.4% (n = 312/361) and 62.6% (n = 226/361) of patients carried FQ-resistant and ESBL-producing E. coli and K. pneumoniae complex, respectively. Approximately 60% (n = 289/483) of the FQ-resistant and 66.0% (n = 202/306) of the ESBL-positive isolates exhibited in vitro resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal E. coli and K. pneumoniae complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% (n = 11/361), with an overall high probability (96.9%) of staying free of infections within the 30 day period post-TRUS-B. Antibiotic use in the previous 3 months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive E. coli and K. pneumoniae complex comprised an independent risk factor for post-biopsy infectious complications. Conclusions The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.

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Section: Discussionmentioning

confidence: 99%

Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy

Obeng‐Nkrumah

Dayie

Addo

et al. 2022

JAC-Antimicrobial Resistance

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“…The use of fluoroquinolones as standard is supported by two meta-analyses showing that fluoroquinolones have significantly better effects compared with placebo in all included trials 3,7 . Other antibiotic agents that have been investigated alone or in addition to fluoroquinolones include trimethoprim-sulfamethoxazole, gentamicin, fosfomycin, piperacillin-tazobactam, amikacin, ceftriaxone, amoxicillin-clavulanate and meropenem 3,6,7,[21][22][23][24] . Most regiments appear to reduce the risk of infection but there is a lack of sufficiently powered randomized trials comparing fluoroquinolones to other antibiotic classes 7 .…”

Section: Discussionmentioning

confidence: 99%

Current routines for antibiotic prophylaxis prior to transrectal prostate biopsy: a national survey to all urology clinics in Sweden

et al. 2020

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Background: The risk of infection after transrectal ultrasound (TRUS)-guided prostate biopsies is increasing. The aim of the study was to assess the use of antibiotic prophylaxis for prostate biopsy in Sweden. Methods: All public and private urology clinics reporting to the National Prostate Cancer Register of Sweden received a survey on TRUS-biopsy prophylaxis. Results: Of the 84 clinics surveyed, 76 replied (90%). If no risk factors for infection were present, a single dose of ciprofloxacin 750 mg was used by 50 clinics (66%). Multiple doses of ciprofloxacin 500 or 750 mg (n=14; 18%) or a single dose of trimethoprim-sulfamethoxazole 160/800 mg (n=7; 9%) were other common prophylaxes. Most clinics gave the prophylaxes immediately before the biopsy (n=41; 54%). Urine dipstick was used by 30 clinics (39%) and rectal enema by six (8%). In patients with high risk of infection, the survey mirrors a large variety of regiments used. Conclusions: The preference to use a single dose of ciprofloxacin 750 mg is in accordance with the Swedish national guidelines for patients with a low risk of infection. Better compliance to the guideline recommendation to use a urine dipstick would probably increase the number of patients classified as having an increased risk of infection. Being classified as a high-risk patient should lead to an extended duration of antibiotic prophylaxis, however, the variety of regimens used in the high-risk group reflects an inability to treat these patients in a standardized fashion and also highlights a need for more clear-cut guidelines. Pre-biopsy identification of high-risk patients is an important issue to tackle for the urologic clinics in order to reduce the number of infections.

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“…In high-risk patients, however, the development is different: some advocate combining an augmented prophylaxis with >2 antibiotics with povidone-iodine bowel preparation in high-risk regions ( 11 ). Others combine ciprofloxacin with amoxicillin/clavulanate ( 12 ) or administer meropenem ( 13 ) for antimicrobial prophylaxis in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prophylaxis in Prostate Biopsies: Contemporary Practice Patterns in Germany

et al. 2018

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PurposeProstate biopsy (pbx) is the most common outpatient procedure in urology. Complications are urinary tract infections, including hospitalization and sepsis. Recommendations on antibiotic prophylaxis (apx) are scarce, and healthcare data are not available. The study addressed the following endpoints: the duration and spectrum of antimicrobial prophylaxis in transrectal and transperineal pbx in the hospital and the practice setting.MethodsA questionnaire compiled data about age, gender, board certification, and place of work. Information about the frequency of pbx, duration and type of apx, usage of disinfecting lubricant, and urine or rectal swab cultures was collected. The study refers to German urologists.ResultsOverall 478 urologists answered the questionnaire. 15.5% (74) of respondents were residents. 50.8% (243) of urologists work in a practice; the rest in a hospital. Only 4.8% do not perform pbx. Transrectal pbx are performed a median of two times a week. The majority (446, 98%) prescribe an apx, mostly fluoroquinolones (407, 89.5%). In total, 10.1% (46) of the participants use a single-shot-apx. apx has a median duration of 4 days. One-third uses a disinfecting lubricant. Urine and rectal swab cultures are analyzed by 45.5% (207) and 24.4% (111), respectively.ConclusionMost urologists prescribe an extended apx for both transrectal and transperineal pbx. Perineal pbx is still a deviation from everyday practice and not an established alternative to transrectal pbx. Urologists are aware of the increasing fluoroquinolone-resistance and are adapting with rectal swab and urine cultures. Further studies need to evaluate alternatives to 5-day apx and results should be addressed in our guidelines. This is of importance in light of the increasing resistance rates and fluoroquinolone side effects.

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A single dose of meropenem is superior to ciprofloxacin in preventing infections after transrectal ultrasound-guided prostate biopsies in the era of quinolone resistance

Abstract: A single dose of meropenem prior to prostate biopsy is a safe and effective way to avoid the possible infectious complications in high-risk patients.

Cited by 11 publications

References 27 publications

Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy

Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy

Current routines for antibiotic prophylaxis prior to transrectal prostate biopsy: a national survey to all urology clinics in Sweden

Antibiotic Prophylaxis in Prostate Biopsies: Contemporary Practice Patterns in Germany

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