Transrectal ultrasound guided prostate biopsy in the era of increasing fluoroquinolone resistance: prophylaxis with single-dose ertapenem

Seitz, Michael; Stief, Christian G.; Waidelich, Raphaela; Bader, Markus; Tilki, Derya

doi:10.1007/s00345-017-2043-3

Cited by 14 publications

(12 citation statements)

References 31 publications

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“…In this context, we confirmed the infection rate of almost zero of recent single‐centre studies [12,24]. Several groups suggested upfront antibiotic augmentation [7,25], even using carbapenem‐based prophylaxis [26,27], to face the alarming worldwide increase of post‐procedural sepsis following TR biopsies [3–6]. Given the global warnings on antibiotic overuse, the TP biopsy infection rate should be regarded as a major reason to prefer the TP over the TR approach.…”

Section: Discussionsupporting

confidence: 80%

Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases

et al. 2020

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To assess the outcomes of multiparametric magnetic resonance imaging (mpMRI) transperineal targeted fusion biopsy (TPFBx) under local anaesthesia. Patients and Methods We prospectively screened 1327 patients with a positive mpMRI undergoing TPFBx (targeted cores and systematic cores) under local anaesthesia, at two tertiary referral institutions, between September 2016 and May 2019, for inclusion in the present study. Primary outcomes were detection of clinically significant prostate cancer (csPCa) defined as (1) International Society of Urological Pathologists (ISUP) grade >1 or ISUP grade 1 with >50% involvement of prostate cancer (PCa) in a single core or in >2 cores (D1) and (2) ISUP grade >1 PCa (D2). Secondary outcomes were: assessment of peri-procedural pain (numerical rating scale [NRS]) and procedure timings; erectile (International Index of Erectile Function) and urinary (International Prostate Symptom Score) function changes; and complications. We also investigated the value of systematic sampling and concordance with radical prostatectomy (RP). Results A total of 1014 patients were included, of whom csPCa was diagnosed in 39.4% (n = 400). The procedure was tolerable (NRS pain score 3.1 AE 2.3), with no impact on erectile (P = 0.45) or urinary (P = 0.58) function, and a low rate of complications (Clavien-Dindo grades 1 or 2, n = 8; grade >2, n = 0). No post-biopsy sepsis was recorded. Twenty-two men (95% confidence interval [CI] 17-29) needed to undergo additional systematic biopsy to diagnose one csPCa missed by targeted biopsies (D1). ISUP grade concordance of biopsies with RP was as follows: k = 0.40 (95% CI 0.31-0.49) for targeted cores alone and k = 0.65 (95% CI 0.57-0.72; P < 0.05) overall. Conclusions The use of TPFBx under local anaesthesia yielded good csPCa detection and was feasible, quick, well tolerated and safe. Infectious risk was negligible. Addition of systematic to targeted cores may not be needed in all men, although it improves csPCa detection and concordance with RP.

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Section: Discussionsupporting

confidence: 80%

Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases

et al. 2020

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“…In the first 7 days following the procedure, there were no documented new infections in either group, indicating that there was no introduction of bacteria via the needle biopsy. This is consistent with previous literature and supports the adoption of the TP route rather than the TR route as a safer method of biopsy by avoiding fecal contamination 2,3,8 . Unfortunately, there was an infectious complication relating to a patient suffering from AUR on day 9 following the operation.…”

Section: Discussionsupporting

confidence: 90%

“…This has resulted in broad‐spectrum carbapenems being used in patients preprocedure and postprocedure 3 . With the introduction of TPBx, there has been a drastic reduction in the rates of procedure‐related infection 8 . Compared with TPBx, UTI is 5.4 times more common when TRUS biopsy is performed, with further increased risk if greater than 12 cores are sampled 2 .…”

Section: Introductionmentioning

confidence: 99%

Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications

et al. 2021

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Objectives To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost. Methods A prospective pilot cohort study of patients undergoing transperineal biopsy was performed. Patients were excluded if they had concurrent flexible cystoscopy or language barriers. Patients had a choice of GA or LA. A prospective questionnaire on Days 0, 1, 7, and 30 was applied. The primary outcome was patient tolerability. Secondary outcomes were cancer detection rate, complication rate, and theater utilization. Results This study included 80 patients (40 GA TPTB and 40 LA PPTAS). Baseline characteristics including age, prostate‐specific antigen (PSA), digital rectal examination (DRE), findings, and prostate volume were comparable between the groups (p = 0.3790, p = 0.9832, p = 0.444, p = 0.3939, respectively). Higher median prostate imaging‐reporting and data system (PI‐RADS) score of 4 (interquartile range [IQR] 2) versus 3 (IQR 1) was noted in the LA group (p = 0.0326). Pain was higher leaving recovery in the GA group however not significantly (p = 0.0555). Median pain score at LA infiltration was 5/10 (IQR 3), with no difference in pain at Days 1, 7, or 30 (p = 0.2722, 0.6465, and 0.8184, respectively). For GA versus LA, the overall cancer detection rate was 55% versus 55% (p = 1.000) with clinically significant cancer in 22.5% versus 35% (p = 0.217). Acute urinary retention (AUR) occurred in 5% of GA and 2.5% of LA patients (p = 1.000). The GA cohort spent longer in theater and in recovery with a median of 93.5 min versus 57 min for the LA group (p = <0.0001). Conclusion This study demonstrates that transperineal biopsy is safely performed under LA with no difference between the cohorts in relation cancer detection or AUR. LA biopsy also consumed less theater and recovery resources. A further larger prospective randomized controlled trial is required to confirm the findings of this study.

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“…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%). However, it is noteworthy that cephalosporins and carbapenems such as ceftriaxone and ertapenem need to be given intravenously or intramuscularly.…”

Section: Discussionmentioning

confidence: 99%

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

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et al. 2021

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Transrectal ultrasound guided prostate biopsy in the era of increasing fluoroquinolone resistance: prophylaxis with single-dose ertapenem

Abstract: A single-dose of 1 g of intravenous ERT applied 1 h before a scheduled transrectal prostate biopsy is a safe option and provides effective protection against infection-related complications arising from surgery.

Cited by 14 publications

References 31 publications

Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases

Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases

Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications

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

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