Urogenit Tract Infect.  2018 Dec;13(3):72-78. 10.14777/uti.2018.13.3.72.

Optimal Modified Extended Antibiotic Prophylaxis for Prostate Biopsy: The Addition of Two Intravenous Doses of Amikacin to Ciprofloxacin

Affiliations
  • 1Department of Urology, Chonnam National University Medical School, Gwangju, Korea. drjsi@yahoo.co.kr

Abstract

PURPOSE
This retrospective study was undertaken to investigate whether increasing amikacin dosage for ciprofloxacin prophylaxis in patients with fluoroquinolone (FQ)-resistant rectal flora reduce infectious complications after transrectal ultrasound-guided prostate biopsy (TRUSPB).
MATERIALS AND METHODS
A total of 430 patients with FQ-resistant rectal flora based on rectal swab cultures were divided into two groups. Patients in both groups were administered ciprofloxacin (400 mg, intravenous [IV], twice daily) on the same day as TRUSPB and one day after biopsy. However, whereas group 1 patients (n=202) were administered a single injection of amikacin (1 g, IV) one hour before TRUSPB, patients in group 2 (n=228) were administered two injections of amikacin (1 g, IV) before one hour TRUSPB and again on the day after TRUSPB.
RESULTS
Of the 430 study subjects, 129 (30.0%) showed extended-spectrum beta-lactamase (ESBL) positivity. The overall incidence rate of infectious complications was 2.8% (12/430). Infectious complication rates were 4.0% (8/202) in group 1 and 1.3% (3/228) in group 2 (p=0.075). Urinary tract infection and acute prostatitis were more frequent in group 1 (3.5% vs. 0.4%, p=0.029). Infectious complication rates in ESBL negative patients were 3.4% (5/145) in group 1 and 1.3% (2/156) in group 2, whereas those in ESBL positive patients were 7.0% (4/57) in group 1 and 1.4% (1/72) in group 2.
CONCLUSIONS
Increasing the dosage of amikacin for ciprofloxacin prophylaxis reduce infectious complications in patients with FQ-resistant rectal flora and to be more effective in ESBL positive patients with FQ-resistant rectal flora.

Keyword

Prostate; Biopsy; Fluoroquinolones; Amikacin; Infection

MeSH Terms

Amikacin*
Antibiotic Prophylaxis*
beta-Lactamases
Biopsy*
Ciprofloxacin*
Fluoroquinolones
Humans
Incidence
Prostate*
Prostatitis
Retrospective Studies
Urinary Tract Infections
Amikacin
Ciprofloxacin
Fluoroquinolones
beta-Lactamases
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