Korean J Urol.  2015 Jun;56(6):466-472. 10.4111/kju.2015.56.6.466.

Antibiotic prophylaxis with intravenous ceftriaxone and fluoroquinolone reduces infectious complications after transrectal ultrasound-guided prostatic biopsy

• Lee C
• You D
• Jeong IG
• Hong JH
• Choo MS
• Ahn H
• Ahn TY
• Kim CS

• KMID: 2160588
• DOI: http://doi.org/10.4111/kju.2015.56.6.466

Abstract

PURPOSE
To assess the rates of infectious complications before and after the change of prophylactic antibiotic regimens in prostate needle biopsy.
MATERIALS AND METHODS
The records of 5,577 patients who underwent prostate needle biopsy at Asan Medical Center between August 2005 and July 2012 were retrospectively reviewed. Group 1 (n=1,743) included patients treated between 2005 and 2009 with fluoroquinolone for 3 days, group 2 (n=2,723) included those treated between 2009 and 2012 with ceftriaxone once before the biopsy and fluoroquinolone before biopsy and continue therapy for 3 days, and group 3 (n=1,111) received the same treatment for more than 7 days after the biopsy. Univariable and multivariable logistic regression models addressed risk factors associated with infectious complication after prostate needle biopsy.
RESULTS
Infectious complication after prostate needle biopsy developed in 18 (group 1), seven (group 2), and two patients (group 3) (p=0.001). In group 1, seven patients with infectious complication had positive blood cultures and harbored fluoroquinolone-resistant Escherichia coli, four had ceftriaxone susceptible isolates, and three had extended spectrum beta-lactamase-positive E. coli. Two patients in group 1 required intensive care because of septic shock. In multivariable analysis, the patients with combination of fluoroquinolone and ceftriaxone had significantly lower infectious complication rate than the fluoroquinolon alone (p=0.003).
CONCLUSIONS
Antibiotic prophylaxis with ceftriaxone and fluoroquinolone before prostate needle biopsy decreased the risk of potentially serious infectious complications.

Keyword

Antibiotic prophylaxis; Biopsy; Ceftriaxone; Infection; Prostate

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Antibiotic Prophylaxis/*methods
Biopsy, Needle/adverse effects/methods
Ceftriaxone/*therapeutic use
Cross Infection/epidemiology/etiology/*prevention & control
Drug Evaluation/methods
Drug Resistance, Bacterial
Drug Therapy, Combination
Escherichia coli/drug effects
Escherichia coli Infections/epidemiology/prevention & control
Fluoroquinolones/*therapeutic use
Humans
Incidence
Male
Middle Aged
Prostatic Neoplasms/*pathology
Republic of Korea/epidemiology
Retrospective Studies
Ultrasonography, Interventional
Young Adult
Ceftriaxone
Fluoroquinolones

Figure

• 

  Fig. 1 (A) Number of prostatic biopsy per 6 months and (B) incidence of infectious complication after prostate needle biopsy of the prostate between 2005 and 2012.

Reference

1. Raaijmakers R, Kirkels WJ, Roobol MJ, Wildhagen MF, Schrder FH. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology. 2002; 60:826–830.

2. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011; 186:1830–1834.

3. 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.

4. Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008; 179:1379–1390.

5. Binsaleh S, Al-Assiri M, Aronson S, Steinberg A. Septic shock after transrectal ultrasound guided prostate biopsy. Is ciprofloxacin prophylaxis always protecting? Can J Urol. 2004; 11:2352–2353.

6. 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.

7. Sabbagh R, McCormack M, Peloquin 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.

8. World Health Organization. Community-based surveillance of antimicrobial use and resistance in resource-constrained settings: report on five pilot projects. Geneva: World Health Organization;2009.

9. Carignan A, Roussy JF, Lapointe V, Valiquette L, Sabbagh R, Pepin J. Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis? Eur Urol. 2012; 62:453–459.

10. Batura D, Rao GG, Nielsen PB. Prevalence of antimicrobial resistance in intestinal flora of patients undergoing prostatic biopsy: implications for prophylaxis and treatment of infections after biopsy. BJU Int. 2010; 106:1017–1020.

11. Schaeffer AJ. The impact of collateral damage on urological care. J Urol. 2012; 187:1527–1528.

12. Batura D, Gopal Rao G. The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention. J Antimicrob Chemother. 2013; 68:247–249.

13. Adam D, Naber KG. Concentrations of ceftriaxone in prostate adenoma tissue. Chemotherapy. 1984; 30:1–6.

14. Feliciano J, Teper E, Ferrandino M, Macchia RJ, Blank W, Grunberger I, et al. The incidence of fluoroquinolone resistant infections after prostate biopsy: are fluoroquinolones still effective prophylaxis? J Urol. 2008; 179:952–955.

15. Rietbergen JB, Kruger AE, Kranse R, Schroder FH. Complications of transrectal ultrasound-guided systematic sextant biopsies of the prostate: evaluation of complication rates and risk factors within a population-based screening program. Urology. 1997; 49:875–880.

16. Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Antimicrobial resistance trends of Escherichia coli bloodstream isolates: a population-based study, 1998-2007. J Antimicrob Chemother. 2009; 64:169–174.

17. Peralta G, Sanchez MB, Garrido JC, De Benito I, Cano ME, Martinez-Martinez L, et al. Impact of antibiotic resistance and of adequate empirical antibiotic treatment in the prognosis of patients with Escherichia coli bacteraemia. J Antimicrob Chemother. 2007; 60:855–863.

18. Laupland KB, Gregson DB, Church DL, Ross T, Pitout JD. Incidence, risk factors and outcomes of Escherichia coli bloodstream infections in a large Canadian region. Clin Microbiol Infect. 2008; 14:1041–1047.

19. Colodner R, Keness Y, Chazan B, Raz R. Antimicrobial susceptibility of community-acquired uropathogens in northern Israel. Int J Antimicrob Agents. 2001; 18:189–192.

20. Kahlmeter G. ECO.SENS. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. J Antimicrob Chemother. 2003; 51:69–76.

21. Livermore DM, James D, Reacher M, Graham C, Nichols T, Stephens P, et al. Trends in fluoroquinolone (ciprofloxacin) resistance in enterobacteriaceae from bacteremias, England and Wales, 1990-1999. Emerg Infect Dis. 2002; 8:473–478.

22. Kehinde EO, Al-Maghrebi M, Sheikh M, Anim JT. Combined ciprofloxacin and amikacin prophylaxis in the prevention of septicemia after transrectal ultrasound guided biopsy of the prostate. J Urol. 2013; 189:911–915.

23. Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schroder FH, Roobol MJ. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol. 2012; 61:1110–1114.

24. Dronge AS, Perkal MF, Kancir S, Concato J, Aslan M, Rosenthal RA. Long-term glycemic control and postoperative infectious complications. Arch Surg. 2006; 141:375–380.

25. Lorber G, Benenson S, Rosenberg S, Gofrit ON, Pode D. A single dose of 240 mg gentamicin during transrectal prostate biopsy significantly reduces septic complications. Urology. 2013; 82:998–1002.

26. Adibi M, Hornberger B, Bhat D, Raj G, Roehrborn CG, Lotan Y. Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic prophylaxis. J Urol. 2013; 189:535–540.

27. Kim JB, Jung SI, Hwang EC, Kwon DD. Prevalence of antibiotic-resistant bacteria on rectal swabs and factors affecting resistance to antibiotics in patients undergoing prostate biopsy. Korean J Urol. 2014; 55:201–206.

28. Duplessis CA, Bavaro M, Simons MP, Marguet C, Santomauro M, Auge B, et al. Rectal cultures before transrectal ultrasoundguided prostate biopsy reduce post-prostatic biopsy infection rates. Urology. 2012; 79:556–561.