Investig Clin Urol.  2019 Jan;60(1):54-60. 10.4111/icu.2019.60.1.54.

Comparing infective complications from transrectal ultrasound guided prostate biopsy following transition to single dose oral ciprofloxacin prophylaxis

• Farag M
• Riddell S
• Daffy J
• Wong LM

• KMID: 2434626
• DOI: http://doi.org/10.4111/icu.2019.60.1.54

Abstract

PURPOSE
To examine the incidence of infective complications post Transrectal Ultrasound Guided Prostate Biopsy (TRUSPB), after transition to preoperative administration of single dose oral ciprofloxacin.
MATERIALS AND METHODS
A retrospective study of 766 consecutive patients undergoing TRUSPB at St Vincent's Hospital Melbourne (2002-2016). Antibiotic prophylaxis between 2002-2014 consisted of 3 days of perioperative oral norfloxacin±intravenous (IV) antibiotics (Group A, n=687). From November 2014 patients received a single dose of oral 750 mg ciprofloxacin pre-biopsy (Group B, n=79), to align with the American Urological Association (AUA) and a Cochrane Database Systematic Review on Antibiotic Prophylaxis for TRUSPB. Groups were compared for all postoperative complications requiring representation and/or readmission within 30 days of biopsy.
RESULTS
In Group A, 10 of 687 patients (1.5%) re-presented with post-procedural fever (temperature >38℃), requiring readmission and IV antibiotic treatment, compared to 4 of the 79 patients (5.1%) in Group B (p=0.02). Positive blood cultures were isolated in 0.9% (n=6, Group A) versus 3.8% (n=3, Group B) (p=0.02). The 4 infectious readmissions in Group B had no prior genitourinary infections, no recent travel and all had a Charlson Comorbidity Index scores < 2. Two patients in Group B cultured Escherichia coli sensitive to ciprofloxacin despite receiving preoperative ciprofloxacin.
CONCLUSIONS
Antibiotic prophylaxis using single dose ciprofloxacin is associated with higher infective complications post TRUSPB. The episodes of ciprofloxacin sensitive E. coli bacteraemia in Group B suggest consideration of a longer course of perioperative antibiotic prophylaxis.

Keyword

Antibiotic prophylaxis; Biopsy; Ciprofloxacin; Fluoroquinolones; Prostate

MeSH Terms

Anti-Bacterial Agents
Antibiotic Prophylaxis
Biopsy*
Ciprofloxacin*
Comorbidity
Escherichia coli
Fever
Fluoroquinolones
Humans
Incidence
Postoperative Complications
Prostate*
Retrospective Studies
Ultrasonography*
Anti-Bacterial Agents
Ciprofloxacin
Fluoroquinolones

Reference

1. Roth H, Millar JL, Cheng AC, Byrne A, Evans S, Grummet J. The state of TRUS biopsy sepsis: readmissions to Victorian hospitals with TRUS biopsy-related infection over 5 years. BJU Int. 2015; 116(Suppl 3):49–53. PMID: 26176815.

2. Sabbagh R, McCormack M, Péloquin F, Faucher R, Perreault JP, Perrotte P, et al. A prospective randomized trial of 1-day versus 3-day antibiotic prophylaxis for transrectal ultrasound guided prostate biopsy. Can J Urol. 2004; 11:2216–2219. PMID: 15182413.

3. Shigemura K, Tanaka K, Yasuda M, Ishihara S, Muratani T, Deguchi T, et al. Efficacy of 1-day prophylaxis medication with fluoroquinolone for prostate biopsy. World J Urol. 2005; 23:356–360. PMID: 16254727.

4. Zani EL, Clark OA, Rodrigues Netto N Jr. Antibiotic prophylaxis for transrectal prostate biopsy. Cochrane Database Syst Rev. 2011; (5):CD006576. PMID: 21563156.

5. Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. Eur Urol. 2013; 64:876–892. PMID: 23787356.

6. Wagenlehner FM, van Oostrum E, Tenke P, Tandogdu Z, Çek M, Grabe M, et al. Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Eur Urol. 2013; 63:521–527. PMID: 22704727.

7. Aus G, Ahlgren G, Bergdahl S, Hugosson J. Infection after transrectal core biopsies of the prostate--risk factors and antibiotic prophylaxis. Br J Urol. 1996; 77:851–855. PMID: 8705220.

8. Bruyère F, Malavaud S, Bertrand P, Decock A, Cariou G, Doublet JD, et al. Prosbiotate: a multicenter, prospective analysis of infectious complications after prostate biopsy. J Urol. 2015; 193:145–150. PMID: 25063492.

9. Lindstedt S, Lindström U, Ljunggren E, Wullt B, Grabe M. Single-dose antibiotic prophylaxis in core prostate biopsy: impact of timing and identification of risk factors. Eur Urol. 2006; 50:832–837. PMID: 16750292.

10. Lundström KJ, Drevin L, Carlsson S, Garmo H, Loeb S, Stattin P, et al. Nationwide population based study of infections after transrectal ultrasound guided prostate biopsy. J Urol. 2014; 192:1116–1122. PMID: 24813343.

11. Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ. Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008; 179:1379–1390. PMID: 18280509.

12. Aron M, Rajeev TP, Gupta NP. Antibiotic prophylaxis for transrectal needle biopsy of the prostate: a randomized controlled study. BJU Int. 2000; 85:682–685. PMID: 10759665.

13. Kapoor DA, Klimberg IW, Malek GH, Wegenke JD, Cox CE, Patterson AL, et al. Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy. Urology. 1998; 52:552–558. PMID: 9763070.

14. Antibiotic Expert Groups [Internet]. Therapeutic guidelines. 2014. 11. cited 2016 Feb 8. Available from: https://tgldcdp-tg-org-au.ezp.lib.unimelb.edu.au/viewTopic?topicfile=surgical-prophylaxis#toc_d1e1921.

15. Patel JB. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: twenty-fifth informational supplement. Wayne: Clinical and Laboratory Standards Institute;2015.

16. Australian Commission on Safety and Quality in Health Care (ACSQHC). AURA 2016: first Australian report on antimicrobial use and resistance in human health. Sydney: Australian Commission on Safety and Quality in Health Care (ACSQHC);2016.

17. Which strategies are effective for reducing the risk of infective complications in men undergoing prostate biopsy? [Internet]. National Institute for Health Research;2015. 9. 21. cited 2016 Feb 12. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42015026354.