Evaluation of targeted antimicrobial prophylaxis for transrectal ultrasound guided prostate biopsy: a prospective cohort trial

BMC Infectious Diseases

Research Article

Teresa R. Zembower¹  Chao Qi²  Marc H. Scheetz³  Robert B. Nadler⁴  Anthony J. Schaeffer⁴  Kelly M. Maxwell⁴  John Cashy⁴ 

[1] Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave., Suite 900, 60611, Chicago, IL, USA;Department of Pathology, Clinical Microbiology Division, Northwestern Memorial Hospital, 303 E. Chicago Ave., Ward 2-140, 60611, Chicago, IL, USA;Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, 531 31st St., Alumni Hall 381, 60515, Downers Grove, IL, USA;Department of Pharmacy, Northwestern Memorial Hospital, 251 E. Huron St., Feinberg Pavilion LC 700, 60611, Chicago, IL, USA;Department of Urology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Tarry 16-703, 60611, Chicago, IL, USA;

关键词: Urology;    Biopsy;    Infection;    Antibacterial agents;   

DOI  :  10.1186/s12879-017-2470-1

 received in 2017-03-02, accepted in 2017-05-16,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWe evaluated the effectiveness of targeted antimicrobial prophylaxis in transrectal ultrasound guided prostate biopsy (TRUSP).MethodsA prospective, non-randomized cohort study was conducted. Rectal swab cultures plated on non-selective blood agar and on selective MacConkey agar supplemented with ciprofloxacin identified ciprofloxacin-susceptible and –resistant gram-negative bacteria (CS-GNB and CR-GNB). Patients with CS-GNB received ciprofloxacin while those with CR-GNB received directed prophylaxis. Infectious complications were defined clinically and microbiologically within 30 days after TRUSP. Data were derived at 7 and 30 days post procedure by questionnaires and electronic medical records. We hypothesized that there would be no difference in the infectious outcomes among the CS and CR groups.ResultsFrom November 1, 2012 to March 31, 2015, 510 men completed the study; 430 (84.3%) had CS-GNB and 80 (15.7%) had CR-GNB. 484 (94.9%) completed the study per protocol, while 26 (5.1%) had an intention-to-treat (ITT) analysis. Of the 484, 475 (98.1%) had no infections, nine (1.9%) had infections, six of which (1.2%) were culture-proven (CP). The nine infections were as follows: five (1.0%) uncomplicated UTIs, one (0.2%) complicated UTI, and three (0.6%) urosepsis. One case of uncomplicated UTI and two cases of urosepsis were not CP, but were diagnosed clinically. ITT outcomes were similar. The infection rates were not statistically different between the CS-and CR-GNB patients (p-value = 0.314; 95% CI 0.8–3.3). The four patients with complicated UTIs or sepsis were hospitalized for a mean of 2.6 days and discharged without sequelae. Of the nine infections, three were antimicrobial prophylaxis failures (two ciprofloxacin and one amikacin); three were likely due to failure of the collection or processing of the rectal swab or increasing bacterial resistance between the time of swab collection and biopsy, and three developed clinical infections with no isolate recovered.ConclusionsTargeted antimicrobial prophylaxis follows the principles of antimicrobial stewardship and achieved a low rate of infectious complications with limited morbidity and no sequelae. This individualized method of prophylaxis may be widely applied. Further studies are needed to explore reasons for targeted prophylaxis failure and to determine comparative efficacy of non-ciprofloxacin-containing targeted prophylaxis regimens.Trial registrationClinicalTrials.gov. NCT01659866. Registered 9 July 2012. First patient enrolled 1 November 2012.

【 授权许可】

CC BY   
© The Author(s). 2017