Abstract
We aimed to compare infection rates for two 3-day antibiotic prophylaxis regimens for transrectal ultrasound-guided prostate biopsy (TRUSgbp) and demonstrate local microbiological trends. In 2008, 558 men and, in 2009, 625 men had TRUSgpb. Regimen 1 (2008) comprised 400 mg Ofloxacin immediately before biopsy and 200 mg 12-hourly for 3 days. Regimen 2 (2009) comprised Ofloxacin 200 mg 12-hourly for 3 days commencing 24 hours before biopsy. 20/558 (3.6%) men had febrile episodes with regimen 1 and 10/625 (1.6%) men with regimen 2 (P = 0.03). E. coli was the most frequently isolated organism. Overall, 7/13 (54%) of positive urine cultures were quinolone resistant and (5/13) 40% were multidrug resistant. Overall, 5/9 (56%) patients with septicaemia were quinolone resistant. All patients were sensitive to Meropenem. There was 1 (0.2%) death with regimen 1. Commencing Ofloxacin 24 hours before TRUSgpb reduced the incidence of febrile episodes significantly. We observed the emergence of quinolone and multidrug-resistant E. coli. Meropenem should be considered for unresolving sepsis.
Highlights
Prostate cancer remains a leading cause of cancer mortality in many Western countries [1, 2]
In the Irish context, commencement of the National Cancer Control Programme for prostate cancer will undoubtedly result in an increase in men having transrectal ultrasound-guided prostate biopsy (TRUSgpb) and being diagnosed with prostate cancer
The diagnosis of prostate cancer is mainly made on TRUSgpb, which is commonly performed and safe but is associated with a small risk of infective complications including symptomatic bacteriuria, bacteraemia, and potentially life-threatening sepsis [3]
Summary
Prostate cancer remains a leading cause of cancer mortality in many Western countries [1, 2]. In the Irish context, commencement of the National Cancer Control Programme for prostate cancer will undoubtedly result in an increase in men having transrectal ultrasound-guided prostate biopsy (TRUSgpb) and being diagnosed with prostate cancer. The diagnosis of prostate cancer is mainly made on TRUSgpb, which is commonly performed and safe but is associated with a small risk of infective complications including symptomatic bacteriuria, bacteraemia, and potentially life-threatening sepsis [3]. Antibiotic prophylaxis is the accepted best practice for patients undergoing TRUSgpb but there is a lack of consensus regarding the optimum regimen [4,5,6]. Bacteriuria after TRUSgpb is decreased with antibiotic prophylaxis compared with placebo [7]. Burden et al highlight the lack of standardized antibiotic guidelines and the general lack of evidence-based practice for TRUSgpb [8]
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