Clinical importance of the antibiotic regimen in transrectal ultrasound-guided biopsy: quinolone versus cephalosporin

Abstract

BackgroundQuinolone is recommended as an antimicrobial prophylaxis to prevent infectious complication after transrectal ultrasound-guided biopsy, but the increased appearance of quinolone-resistant organism has raised concerns about the efficacy of quinolone. The current study was performed to evaluate various clinical factors including antimicrobial regimens associated with infectious complication after transrectal ultrasound-guided prostate biopsy.MethodsThe medical records of 5215 patients who underwent a multicore transrectal ultrasound-guided prostate biopsy between May 2003 and January 2013 at our institution were reviewed. We analyzed clinical variables including prostate-specific antigen, International Prostate Symptom Score, antimicrobial regimen, prostate size, and number of biopsy cores. Univariate and multivariate logistic regression analyses of infection-related hospitalization after prostate biopsy were performed.ResultsThe mean age and median prostate-specific antigen of the entire cohort were 66 years and 6.4 ng/ml, respectively. Twenty-eight (0.54 %) patients developed an infectious complication after prostate biopsy that required hospitalization. Patients who received prophylactic quinolone showed a higher infectious hospitalization rate than patients who received prophylactic third-generation cephalosporin (1.5 vs. 0.3 %; p < 0.001). Multivariate logistic regression analysis demonstrated that the International Prostate Symptom Score (odds ratio = 3.18, 95 % confidence interval 1.24–8.13, p = 0.016) and the use of third-generation cephalosporin (odds ratio = 0.21, 95 % confidence interval 0.10–0.44, p < 0.001) were independent predictors of infection-related hospitalization after prostate biopsy.ConclusionWith the emergence of quinolone-resistant microorganisms, third-generation cephalosporin may effectively reduce the risk of infectious complications after transrectal ultrasound-guided prostate biopsy. Severe lower urinary tract symptoms may also be an independent risk factor for infection-related hospitalization after transrectal ultrasound-guided prostate biopsy.

A prospective randomized trial of povidone-iodine suppository before transrectal ultrasonography-guided prostate biopsy

“…[25,26] In addition, we previously reported that the use of third-generation cephalosporins is highly effective in reducing the risk of infectious complications as compared with the use of fluoroquinolone. [27] On the basis of these reports, we also used third-generation cephalosporins in this study. As a result, the absence of infectious complications in all 250 patients in the treatment and control groups in this study accounts for the superior prophylactic effect of third-generation cephalosporins.…”

Comparison of Complication Rates with Antibiotic Prophylaxis with Cefpodoxime Versus Fluoroquinolones After Transrectal Prostate Biopsy

“…For example, Cai et al [26] investigated whether fosfomycin has sufficient efficacy as antibiotic prophylaxis for transrectal prostate biopsy and reported a symptomatic urinary tract infection rate of 1.6%. Other investigators evaluated cephalosporins such as ceftriaxone as an alternative with sufficient relative to flouroquinolones as antibiotic prophylaxis for transrectal prostate biopsy [16,27,28]. In addition, Seitz et al [29] showed a significant reduction in infectious complication with single-shot ertapenem versus ciprofloxacin antibiotic prophylaxis (0.8% vs 14.5%).…”

“…Since the European Medicines Agency (EMA) recommended more restrictive use of fluoroquinolones because of potentially permanent side effects, several studies have compared the efficacy of antibiotic prophylaxis for prostate biopsy with different antibiotic regimes [12][13][14][15][16]. To the best of our knowledge, no previous study has explicitly investigated complication rates after prostate biopsy with cefpodoxime as oral antibiotic prophylaxis.…”

Minimizing transrectal prostate biopsy-related infections; A prospective randomized trial of povidone-iodine intrarectal cleaning versus formalin needle disinfection

“…Due to local bacterial susceptibility to cephalosporins and resistance to quinolones, our study patients were given single dose of oral cefuroxime 500 mg once on the day of procedure. [ 16 ] Patients needing Foley catheterization after biopsy were excluded from the analysis, as catheterization could independently increase risk of infectious complications. The study's endpoint was development of signs and symptoms of infection, as previously defined, within a week of biopsy.…”