Chemoprophylaxis during transrectal prostate needle biopsy: critical analysis through randomized clinical trial

Elshal, Ahmed M.; Atwa, Ahmed; El-Nahas, Ahmed R.; El-Ghar, Mohamed Abou; Gaber, Asaad; Elsawy, Essam; Hashem, Abdelwahab; Farag, Yasser; Farg, Hashim; Elsorougy, Ali; Fouda, Mohamed A.; Nabeeh, Hossam; Mosbah, Ahmed

doi:10.1007/s00345-018-2319-2

Cited by 18 publications

(8 citation statements)

References 30 publications

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“…35e40 However, the largest RCT used only a single shot targeted prophylaxis compared to a 3-day regimen of standard or augmented prophylaxis and showed comparable infectious complications with targeted and empiric prophylaxis. 35 This is in concordance with our analysis showing that a single shot prophylaxis is insufficient.…”

Section: Discussionsupporting

confidence: 91%

Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis

et al. 2020

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Purpose: Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been banned by the European Commission. In this systematic review we summarize the evidence for different antibiotic prophylaxis regimens. Materials and Methods: We searched MEDLINEÒ, EmbaseÒ and Cochrane Database for randomized controlled trials (inception to October 2019) assessing antimicrobial interventions in prostate biopsy. Primary outcome was infectious complications. Exclusion criteria were simultaneous interfering interventions. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used to assess the certainty of evidence. Protocol was registered with PROSPERO (CRD42015026354). Results: Overall 59 randomized controlled trials (14,153 participants) and 7 different antimicrobial interventions were included. Antibiotic prophylaxis reduced infectious complications compared to no prophylaxis (RR 0.56, 95% CI 0.40e0.77, p[0.0005, I 2 [15%, participants 1,753, studies 11). A short-term prophylaxis (single shot to 3 days) was inferior to a long-term prophylaxis (1 to 7 days) with fluoroquinolone (RR 1.89, 95% CI 1.37e2.61, p[0.0001, I 2 [0%, participants 3,999, studies 17). Fosfomycin trometamol was an alternative to fluoroquinolone with reduced rates of infectious complications (RR 0.49, 95 CI 0.27e0.87, p[0.02, I 2 [54%, participants 1,239, studies 3). Empiric prophylaxis was inferior to targeted prophylaxis (RR 1.81, 95% CI 1.28e2.55, p[0.0008, I 2 [48%, participants 1,511, studies 6). Standard prophylaxis was inferior to augmented prophylaxis (using multiple rather than single agent) using a fixed model (RR 2.10, 95% CI 1.53e2.88, p <0.0001, I 2 [71%, participants 2,597, studies 9), but not using a random model (p[0.07). No difference was observed in infectious complications based on route or timing of antimicrobial prophylaxis. The certainty of evidence was rated as low/very low. Conclusions: In countries where fluoroquinolones are allowed as antibiotic prophylaxis, a minimum of a full 1-day administration as well as targeted therapy in case of fluoroquinolone resistance is recommended. In countries Abbreviations and Acronyms MA [ meta-analysis RCT [ randomized controlled trial RoB [ risk of bias SR [ systematic review UTI [ urinary tract infection

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Section: Discussionsupporting

confidence: 91%

Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis

et al. 2020

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“…Elshal et al compared the post-transrectal biopsy infectious complication (TBIC) rate between patients separated into standard (3 days 500mg ciprofloxacin twice daily, beginning the night before the biopsy), augmented (ciprofloxacin and single 160mg gentamicin IM), and targeted prophylaxis (based on results of rectal swab cultures). There was a lower rate of TBICs among the patients allocated to the augmented prophylaxis group, regardless of the variation in the number of biopsy cores taken when compared to the other two groups [10].…”

Section: Prophylaxis Of Uti Following Transrectal Biopsymentioning

confidence: 80%

Metagenomics in diagnosis and improved targeted treatment of UTI

et al. 2019

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The genomic revolution has transformed our understanding of urinary tract infection (UTI). There has been a paradigm shift from the dogmatic statement that urine is sterile in healthy people, as we are becoming forever more familiar with the knowledge that bacterial communities exist within the urinary tracts of healthy people. Metagenomics can investigate broad populations of microbial communities, analyzing all the DNA present within a sample, providing comprehensive data regarding the state of the microenvironment of a patient's urinary tract. This permits medical practitioners to more accurately target organisms that may be responsible for disease-a form of 'precision medicine'. This paper explores the limitations of traditional methods of culture and sensitivity and delves into the recent studies involving new high-throughput genomic technologies in urological research, demonstrating the advances made in the role of urinary microbiome in a whole spectrum of pathologies from urinary tract infection, to prostate cancer. Finally, we discuss the challenges that must be overcome for such technology to become widely used in clinical practice.

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“…While in two studies infectious complications occurred only in the standard prophylaxis group [20,21], the third study showed an equal distribution of infectious complications [19]. Of note, the later study demonstrated an unusually high rate of infectious complications with a sepsis rate of 5.2% among all groups [19]. To give a final recommendation, a meta-analysis of the available RCTs is mandatory.…”

Section: Targeted Antibiotic Prophylaxismentioning

confidence: 99%

“…The authors further concluded that fluoroquinolone resistance drives the higher rates of infectious complications in the standard antibiotic prophylaxis group [18]. To date, a total of three RCTs have been published involving 1337 patients [19][20][21] (Table 2).…”

Section: Targeted Antibiotic Prophylaxismentioning

confidence: 99%

Update on Strategies to Reduce Infectious Complications After Prostate Biopsy

Pilatz

Veeratterapillay

Köves³

et al. 2019

European Urology Focus

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Chemoprophylaxis during transrectal prostate needle biopsy: critical analysis through randomized clinical trial

Abstract: Augmented prophylaxis with single-dose gentamicin is an effective and practical approach. Targeted prophylaxis might be reserved for cases with contraindication to gentamicin.

Cited by 18 publications

References 30 publications

Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis

Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis

Metagenomics in diagnosis and improved targeted treatment of UTI

Update on Strategies to Reduce Infectious Complications After Prostate Biopsy

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