Antibiotics for Transrectal Ultrasonography‐guided Prostate Biopsy: Are We Practising Evidence‐based Medicine?

Burden, Helena; Ranasinghe, Weranja; Persad, Raj

doi:10.1111/j.1464-410x.2008.07556.x

Cited by 21 publications

(20 citation statements)

References 19 publications

(29 reference statements)

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“…11 Alternative choices to attempt to cover the common organisms E. coli, K. pneumoniae, P. aeruginosa and Enterococcus include another fluoroquinolone, a second or third generation cephalosporin or gentamicin. 5,12 There is no good evidence supporting the use of metronidazole. 12 Significant rectal bleeding has been reported at an incidence of 0.1% to 1%.…”

Section: Discussionmentioning

confidence: 99%

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Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Toren

Razik

Trachtenberg

2013

CUAJ

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We report 2 cases of catastrophic complications following routine transrectal ultrasound guided prostate biopsy. The first patient incurred near-fatal septic shock due to multi-resistant Escherichia coli. Due to the severity of his shock, he developed bilateral leg gangrene requiring amputations. The second patient incurred significant hemorrhage eventually requiring an emergent general anesthesia and surgical management to control hemorrhage after other measures failed. While rare events, these reports emphasize the caution needed for physicians who routinely order prostate biopsies.Can Urol Assoc J 2010;4(1):E12-E14 Case 1A 63-year-old diabetic underwent transrectal ultrasound (TRUS)-guided prostate biopsy for an elevated PSA of 5.7 ng/mL and no findings on digital rectal examination (DRE). His past medical history included coronary bypass surgery, dyslipidemia and previous hospital admission for bronchitis. He smoked half a pack of cigarettes per day for 25 years.The day prior to his biopsy, he was initiated on ciprofloxacin 500 mg orally, 2 times a day. The night after his biopsy, he presented to the emergency room with a fever, chills, pain and breathlessness. He appeared septic, with a systolic blood pressure of 75 mmHg, temperature 39º C. Initial white blood count (WBC) was 1.1, with a critically low neutrophil count of 0.44. He was given fluids, ceftriaxone and flagyl in the emergency room. Subsequently, he was transferred to the intensive care unit (ICU) and started on ionotropes and empiric meropenem. He developed hypoxia and was intubated and sedated.During the first 4 days of admission, he continued to be unstable and hypotensive requiring ionotropic support and developing shock liver and renal failure. Solucortef and caspofungin were started; he also received a dose of amikacin. His WBC peaked at 42 on the fourth day of admission. Platelets remained very low at 21 and his international normalized ratio (INR) increased from normal to 2.13. Multi-resistant Escherichia coli was cultured from his blood and was initially only sensitive to amikacin, but eventually also found to be sensitive to meropenem.Against expectations, he survived and slowly recovered. A tracheostomy was performed, and he was eventually weaned off ventilation. As a result of his severe sepsis, he developed bilateral feet gangrene requiring bilateral below knee amputations. Further, he incurred ototoxicity requiring hearing aids. His thrombocytopenia, renal and liver failure resolved over time. He was in the ICU for a total of 46 days and in hospital for 85 days.His prostate biopsy did not show any evidence of malignancy. Case 2A 65-year-old pediatrician was sent for a TRUS biopsy of the prostate for a prostate-specific antigen (PSA) of 10.56 mg/L and a suspicious DRE. His medical history included coronary artery disease with previous coronary artery bypass grafting, hypertension and hypercholesterolemia. He had a mitral valve annuloplasty for mitral regurgitation. He experienced bleeding at the biopsy site immediately after ...

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Section: Discussionmentioning

confidence: 99%

“…5,12 There is no good evidence supporting the use of metronidazole. 12 Significant rectal bleeding has been reported at an incidence of 0.1% to 1%. 1,2, 13 The incidence of bleeding complications has not been shown to increase with either coumadin use or with the use of acetylsalicylic acid.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Toren

Razik

Trachtenberg

2013

CUAJ

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“…Fluoroquinolone antibiotics, such as ciprofloxacin, are the most popular prophylactic agents used in trans-rectal prostatic biopsy (18). Ciprofloxacin has a broad spectrum of activity especially against most gram-negative organisms that cause UTIs (19).…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Controlled Study of the Results of Medication with Oral Ciprofloxacin versus Oralcefixime to Prevent Transient Bacteraemia and Adverse Events from Trans-Rectal Prostatic Biopsy

2016

ARC Journal of Urology

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“…1 Antibiotic prophylaxis has become an important measure to prevent these complications with FQ used to prevent infectious complications. 2,3 The 2008 AUA Best Practice Policy Statement recommends FQ prophylaxis before TRUSB along with preferred second line agents. 4 Despite this recommendation there have been increasing rates of infection related complications after TRUSB.…”

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confidence: 99%

Fluoroquinolone Resistance in the Rectal Carriage of Men in an Active Surveillance Cohort: Longitudinal Analysis

et al. 2015

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Purpose Rectal swabs can identify men with fluoroquinolone resistant bacteria and decrease the infection rate after transrectal ultrasound guided prostate biopsy by targeted antimicrobial prophylaxis. We evaluated the rate of fluoroquinolone resistance in an active surveillance cohort with attention to factors associated with resistance and changes in resistance with time. Materials and Methods We evaluated 416 men with prostate cancer on active surveillance who underwent rectal swabs to assess the rate of fluoroquinolone resistance compared to that in men undergoing diagnostic transrectal ultrasound guided prostate biopsy. The chi-square test and Student t-test were used to compare categorical and continuous variables, respectively. Poisson regression analysis was used for multivariate analysis. Results On the initial swab fluoroquinolone resistance was found in 95 of 416 men (22.8%) on active surveillance compared to 54 of 221 (24.4%) in the diagnostic biopsy cohort (p = 0.675). Diabetes was found in 4.0% of the fluoroquinolone sensitive group vs 14.7% of the resistant group (p <0.001). Biopsy history was not associated with resistance. Of those with a resistant first swab 62.9% had a resistant second swab and 88.9% of those with 2 resistant swabs showed resistance on the third swab. Of men with a sensitive first swab 10.6% showed resistance on the second swab and 10.6% of those with 2 sensitive swabs had resistant third swabs. Conclusions One of 4 men who present for surveillance and diagnostic trans-rectal ultrasound guided prostate biopsy have rectal flora resistant to fluooquinolone. Resistance is significantly associated with diabetes but the number of prior biopsies is not. Men with fluoroquinolone resistant flora tend to remain resistant with time.

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Antibiotics for Transrectal Ultrasonography‐guided Prostate Biopsy: Are We Practising Evidence‐based Medicine?

Cited by 21 publications

References 19 publications

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Prospective Randomized Controlled Study of the Results of Medication with Oral Ciprofloxacin versus Oralcefixime to Prevent Transient Bacteraemia and Adverse Events from Trans-Rectal Prostatic Biopsy

Fluoroquinolone Resistance in the Rectal Carriage of Men in an Active Surveillance Cohort: Longitudinal Analysis

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