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Transrectal ultrasound guided prostate biopsy in the era of increasing fluoroquinolone resistance: prophylaxis with single-dose ertapenem

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Abstract

Purpose

The aim of the study was to compare single-dose ertapenem (ERT) with the 3-day regime of ciprofloxacin (CIP) for prophylaxis of possible infections following transrectal prostate biopsy.

Methods

Data from a consecutive group of 542 patients from January 2012 to January 2017 were retrospectively analysed. As preinterventional prophylaxis patient group A (179) received 500 mg CIP twice a day for three days, beginning on the day before the biopsy (until June 2013); group B (363) received a single dose of ERT 60 min prior to intervention. The first follow-up examination for all patients was between post-intervention days 2 and 3. The second follow-up examination was between day 15 and 30 following biopsy. Urine was cultured in all cases and any adverse drug reactions (ADRs) related to the antibiotic treatment were noted. We also recorded all clinically relevant morbidities requiring intervention (ischuria, macrohaematuria, symptomatic urinary tract infections and urosepsis), as well as those not requiring active intervention (macrohaematuria, decreased urinary stream, pain, haemospermia). The main study criterion was the symptomatic urinary tract infection rate and ADRs.

Results

All 542 biopsied patients could be included in the study and the drop-out rate was zero. There were no significant differences between groups A and B with regards to complications not requiring intervention. There was, however, a significant reduction from 14.5% (group A) to 0.8% (group B) in infectious complications. This showed a significant correlation in favour of ERT (p < 0.001). Furthermore, in the ERT group there was also a distinct and significant reduction (p > 0.001) in the number of patients with bacteriuria (>10e4 cfu per ml urine) without fever (0.5%) compared to the CIP group (12.3%).

Conclusion

A single-dose of 1 g of intravenous ERT applied 1 h before a scheduled transrectal prostate biopsy is a safe option and provides effective protection against infection-related complications arising from surgery.

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Author’s contribution

M Bader: Manuscript editing. M Seitz: Protocol/Data collection/Data analysis/Manuscript writing/editing. C Stief: Manuscript editing. D Tilki: Data analysis/Manuscript editing. R Waidelich: Manuscript editing.

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Authors and Affiliations

  1. UroClinic Munich GbR, Campus Bogenhausen, University Hospital Munich, Ludwig-Maximilians-University, Richard-Strauss-Strasse 82, 81679, Munich, Germany

    Michael Seitz

  2. Department of Urology, University Hospital Munich, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany

    Christian Stief & Raphaela Waidelich

  3. UroClinic Munich GbR, Campus Giesing, University Hospital Munich, Ludwig-Maximilians-University Munich, Giesinger Bahnhofplatz 2, 81539, Munich, Germany

    Markus Bader

  4. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Derya Tilki

  5. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany

    Derya Tilki

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  1. Michael Seitz
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Correspondence to Michael Seitz.

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All authors have nothing to declare and no competing financial interests in relation to the work described.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Seitz, M., Stief, C., Waidelich, R. et al. Transrectal ultrasound guided prostate biopsy in the era of increasing fluoroquinolone resistance: prophylaxis with single-dose ertapenem. World J Urol 35, 1681–1688 (2017). https://doi.org/10.1007/s00345-017-2043-3

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  • DOI: https://doi.org/10.1007/s00345-017-2043-3

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