Comparison of Fluoroquinolones and Other Antibiotic Prophylaxis Regimens for Preventing Complications in Patients Undergoing Transrectal Prostate Biopsy

Abstract

Our study aimed to compare the incidence of infective complications after transrectal ultrasound-guided prostate biopsy (TRUSBx) when adopting different antimicrobial prophylaxis regimens. A multi-institutional cohort of 1150 patients who underwent TRUSBx was retrospectively analyzed. Procedures were performed between 2017 and 2019 (before and after the EMA warning about the use of fluoroquinolones for the antibiotic prophylaxis of patient candidates to TRUSBx). The primary endpoint was the occurrence of infective complications, including sepsis and/or fever. The population was stratified according to the antibiotic prophylaxis adopted: fluoroquinolones (levofloxacin, ciprofloxacin, prulifloxacin), cephalosporins (cefixime, ceftriaxone) or trimethoprim/sulfamethoxazole. Univariable and multivariable binomial logistic regression models were used to assess the odds ratio (OR) with 95% confidence interval (CI) testing of the risk of infective complication after adjusting for each prebiopsy covariate. In total, 478 (41.6%) patients received fluoroquinolone-based prophylaxis. Among these, 443 (38.5%), 25 (2.2%) and 10 (0.9%) patients received levofloxacin prophylaxis, ciprofloxacin and prulifloxacin, respectively while 14.6% received cefixime, 20.7% received the comedication of ceftriaxone/fosfomycin and 23.1% received trimethoprim/sulfamethoxazole. The trimethoprim/sulfamethoxazole and fluoroquinolone regimens were significantly associated with a lower risk of infective complications (OR 0.15, 95% CI 0.03–0.48, p = 0.003 and OR 0.17, 95% CI 0.06–0.43, p < 0.001, respectively). The ceftriaxone/fosfomycin (OR 0.21, 95% CI 0.04–0.92, p = 0.04) and fluoroquinolone (OR 0.07, 95% CI 0.00–0.70, p = 0.048) prophylaxis were associated with a lower risk of infective sequelae. Fluoroquinolone-based prophylaxis was associated with a lower risk of infective complications after TRUSBx compared to other prophylaxis regimens although its clinical application was recently forbidden by European Medical Agency restrictions.

Effectiveness of fosfomycin-based antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: A Korean multicenter study

“…Although several studies examining the effectiveness of FM compared with FQ showed that the use of FM alone would be an attractive alternative to FQ as prophylaxis for TRUSPB [ 11 12 13 14 ], this was not the case in the Republic of Korea. However, a combination of FM and FQ was observed to be effective in reducing post-biopsy infections [ 9 ], which may be attributed to regional differences in the antibiotic resistance pattern [ 6 ].…”

“…With increasing antibiotic-resistant bacterial infections, particularly high fluoroquinolone (FQ) resistance in the Republic of Korea [ 5 6 ], alternative antimicrobial prophylaxis is required to prevent post-TRUSPB-related infections. Owing to its good permeability into prostate tissue and lower resistance rate [ 7 ], FM trometamol has emerged as an alternative to FQ for the prophylaxis of post-biopsy infectious complications.…”

Biopsia transrectal de próstata con ceftriaxona como profilaxis antibiótica. Experiencia en 777 pacientes

“…Desde la descripción original de Nash en 1996, el estándar para la biopsia prostática es el uso de anestesia local para bloqueo periprostático, disminuyendo considerablemente el dolor 5 . Por otro lado, para disminuir las complicaciones infecciosas, el uso de povidona yodada rectal antes de la biopsia y la administración de profilaxis antimicrobiana han demostrado ser efectivos en la prevención de complicaciones infecciosas, pero no existe evidencia de que un esquema de antibióticos sea mejor que otro 6 . También se ha introducido el uso de enema rectal evacuante previo al procedimiento, aunque no hay trabajos que lo recomienden fuertemente.…”

Micro-Ultrasound in the Diagnosis and Staging of Prostate and Bladder Cancer: A Comprehensive Review

“…Furthermore, TRUS seems no more accurate than DRE at predicting organ-confined PCa [6]. However, real-time ultrasound (US) guidance remains critical for performing both systematic and fusion prostate biopsies [7][8][9]. As part of the new imaging exams, prostate-specific membrane antigen positron emission tomography/CT (PSMA PET/CT) has gained great popularity in recent years.…”