The Effectiveness of Targeted Relative to Empiric Prophylaxis on Infectious Complications After Transrectal Ultrasound-guided Prostate Biopsy: a Meta-analysis

Overview

Journal World J Urol

Specialty Urology

Date 2018 Feb 18

PMID 29453690

Citations 16

Authors

Susan Scott

Patrick N Harris

Deborah A Williamson

Michael A Liss

Suhail A R Doi

Matthew J Roberts

Affiliations

Soon will be listed here.

Abstract

Purpose: Rectal culture screening for fluoroquinolone (FQ)-resistant Enterobacteriaceae before transrectal ultrasound guided prostate (TRUSPB) biopsy and targeted antibiotic prophylaxis (TAP) may decrease post-TRUSPB infection rates compared to empiric (EAP) regimens. The objective of this study was to evaluate the effectiveness of targeted relative to empiric prophylaxis regimens on rates of infectious complications after TRUSPB and to determine the baseline prevalence of FQ resistance based on prior rectal swabs.

Methods: An electronic search within literature databases including EMBASE and Web of Science (all databases) for articles assessing TAP as an approach to TRUSPB prophylaxis was conducted. Quality assessment was performed using the Hoy instrument. Meta-analysis was performed using MetaXL 5.3.

Results: From 15 studies (eight retrospective and seven prospective) representing 12,320 participants, infectious complication incidence was 3.4% in EAP and 0.8% in TAP patients. The number needed to treat with TAP to avoid one more infection when compared to the EAP group was 39. Effect sizes were homogeneous. Prevalence of FQ resistance showed low (15%) and high (28%) subgroups, likely due to region of origin (within and outside USA, respectively).

Conclusions: Rectal culture prior to TRUSPB and use of TAP adjusts for endemic FQ resistance and is associated with less infectious complications and resulting morbidity when compared to EAP. Overtreatment associated with augmented prophylaxis approaches may be reduced as a result. Further prospective assessment and cost-benefit analyses are required before widespread implementation can be recommended.

Citing Articles

Infectious complications of transrectal prostate biopsy in patients receiving targeted antibiotic prophylaxis after urethral and rectal swab versus standard prophylaxis: A prospective comparative study.

Gatsos S, Kalogeras N, Dimakopoulos G, Samarinas M, Papakonstantinou A, Petinaki E Prostate Int. 2024; 12(1):35-39.

PMID: 38523904 PMC: 10960084. DOI: 10.1016/j.prnil.2023.11.002.

Clinical Value of a Routine Urine Culture Prior to Transrectal Prostate Biopsy.

Ortegren J, Wimmerstedt A, Aberg D, Janson H, Kjolhede H, Kahlmeter G Eur Urol Open Sci. 2023; 48:54-59.

PMID: 36743399 PMC: 9895763. DOI: 10.1016/j.euros.2022.11.024.

Ciprofloxacin Alone vs. Ciprofloxacin plus an Aminoglycoside for the Prevention of Infectious Complications following a Transrectal Ultrasound-Guided Prostate Biopsy: A Retrospective Cohort Study.

Thirion D, Caissy J, Poulin F, Lanfranchi C, Deda A, Aprikian A Antibiotics (Basel). 2023; 12(1).

PMID: 36671257 PMC: 9854471. DOI: 10.3390/antibiotics12010056.

Molecular genetic testing does not improve the detection of fluoroquinolone resistance before transrectal prostate biopsy.

Liss M, Garg H, Sokurenko E, Patterson J, Wickes B Prostate Int. 2022; 10(4):194-199.

PMID: 36570643 PMC: 9747570. DOI: 10.1016/j.prnil.2022.06.005.

Rectal Culture-Based Versus Empirical Antibiotic Prophylaxis to Prevent Infectious Complications in Men Undergoing Transrectal Prostate Biopsy: A Randomized, Nonblinded Multicenter Trial.

Tops S, Kolwijck E, Koldewijn E, Somford D, Delaere F, van Leeuwen M Clin Infect Dis. 2022; 76(7):1188-1196.

PMID: 36419331 PMC: 10069853. DOI: 10.1093/cid/ciac913.

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