“Targeted” prophylaxis: Impact of rectal swab culture-directed prophylaxis on infectious complications after transrectal ultrasound-guided prostate biopsy

Abstract

PurposeTo assess the prevalence of fluoroquinolone resistance among patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy and the impact of rectal swab culture-directed antibiotic prophylaxis on postbiopsy infectious complications.Materials and MethodsWe prospectively analyzed all patients undergoing TRUS-guided prostate biopsy from April 2013 to February 2015. Antibiotic prophylaxis was tailored to the results of rectal swab cultures. If the organism was fluoroquinolone-sensitive, oral ciprofloxacin 500 mg with tinidazole 600 mg was prescribed. If the organism was fluoroquinolone-resistant, then a culture-directed antibiotic was prescribed. In both cases the antibiotic was continued for 3 days. All patients were followed for 14 days after biopsy to record infectious complications.ResultsA total of 247 patients were included, and Escherichia coli was isolated on rectal swab cultures in 99.5% of the patients. Of these, 41.7% harbored fluoroquinolone-resistant E. coli. Piperacillin/tazobactam was the most common culture-directed antibiotic prescribed (59.3%), with amoxicillin/clavulanic being the second most common (25.5%) for the fluoroquinolone-resistant group. Only 2 patients (0.9%) developed postbiopsy fever and none had sepsis.ConclusionsColonization of rectal flora with fluoroquinolone-resistant E. coli was seen in 40% of men undergoing prostate biopsy. Targeted prophylaxis, which uses the results of prebiopsy rectal swab culture to direct antibiotic prophylaxis, results in low rates of postbiopsy infections.

A Comprehensive Review of Pharmaceutical and Surgical Interventions of Prostate Cancer

“…While age causes an increase in PSA, studies have shown that certain pharmaceutics has also been known to impact PSA levels: statins, thiazide diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), and 5-alpha-reductase inhibitors [6,7]. These specific medications have been noted to decrease PSA levels, and thus, a rise in PSA levels in a patient on these medications would evidently cause suspicion of prostate cancer [7,30]. The definitive method in diagnosing prostate cancer would be conducting a prostate biopsy.…”

Post‐prostate biopsy acute bacterial prostatitis and screening cultures using selective media: An overview

“…A Japanese study reported complications in a cohort of 376 men; specifically, fever (≥38°C) and sepsis were noted in 1.1% and 0.07% of patients, respectively 8 . A prospective series involving the impact of rectal swab cultures and infectious complications in 247 patients reported fever in <1% of cases, which required no further intervention or hospital admission, even though FQ‐resistant E. coli was isolated in 41.7% of the cases 9 . The rise in antibiotic‐resistant pathogens accounts for the risk factors most commonly observed in patients developing infectious complications and acute prostatitis 10 .…”

“…Of 247 patients, 99.5% were E . coli ‐positive, and among those, 41.7% harbored FQ‐resistant strains 9 . In a similar study from Colombia, rectal swabs were used to determine the impact on infectious complications after transrectal biopsy.…”

“…Of 247 patients, 99.5% were E. colipositive, and among those, 41.7% harbored FQ-resistant strains. 9 In a similar study from Colombia, rectal swabs were used to determine the impact on infectious complications after transrectal biopsy. Of 548 men, 45.62% had FQresistant bacteria, and hospital admissions due to infectious complications were reduced after the implementation of selective culture media before the prostate biopsy.…”

“…8 A prospective series involving the impact of rectal swab cultures and infectious complications in 247 patients reported fever in <1% of cases, which required no further intervention or hospital admission, even though FQresistant E. coli was isolated in 41.7% of the cases. 9 The rise in antibiotic-resistant pathogens accounts for the risk factors most commonly observed in patients developing infectious complications and acute prostatitis. 10 These organisms are most often directly inoculated from the large bowel into the prostate or surrounding tissues.…”