Transrectal Ultrasonography Prostate Biopsy Research Articles

634 - Prevalence and significance of fluoroquinolone-resistant bacteria carriage in patients undergoing trans rectal ultra-sonography prostate biopsy

To determine the prevalence of fluoroquinolone-resistant (FQR) bacteria carriage in patients undergoing transrectal ultrasound prostate biopsy (TRUS-Bx), and the relationship between the risk factors and FQR carriers as well as infections after prostate biopsy.Rectal swabs were obtained from 158 patients undergoing TRUS-Bx. The FQR organisms were isolated using selective media, and the antibiotic susceptibility pattern was determined. Moreover, after prostate biopsy, blood and urine samples were collected from patients with post-biopsy infection (PBI) during 30days of follow up.In total, 73 (46.2%) patients were positive for ciprofloxacin-resistant bacteria in rectal cultures. The most dominant isolates were Escherichia coli (95.9%). The antibiotic susceptibility patterns for the FQR rectal and clinical isolates showed high levels of resistance to ampicillin (94%) and trimethoprim-sulfamethoxazole (89.5%), while the resistance to amikacin, fosfomycin and imipenem remained very low. The multivariate analysis showed that previous use of FQs (OR, 2.54; 95% CI, 1.17-5.49; P = .019) and history of hospitalization (OR, 7.85; 95% CI, 2.075-29.744; P = .002) were significantly risk factors for the FQR carriage. On the other hand, the risk of PBI was higher among intestinal carriers of fluoroquinolone resistant bacteria compared with noncarriers, that this difference was statistically significant (24% versus 3.5%, P < .001).The rates of PBI and hospitalization after TRUS-Bx were 12.5%, and 4.43%, respectively.An increase in the rectal FQR bacteria carriage is associated with elevated PBI, which strongly recommendsthe need for an appropriate prophylaxis to reduce infections in patients undergoing TRUS-Bx.

ANTIBIOTIC PROPHYLAXIS WITH DIFFERENT ANTIBIOTIC REGIMEN IN PROSTATE BIOPSY PATIENTS

Objective: To know the incidence of urinary tract infection (UTI) with different antibiotic prophylaxis for transrectal ultrasonography (TRUS) prostate biopsy. Material & Method: The study included 34 patients at Soetomo Hospital Surabaya, who were divided into 2 groups, each group consisting of 17 patients. In the first group patients received 1000 mg of ciprofloxacin orally, in the second group cefotaxime 1000 mg iv was given prior to biopsy. The two groups were compared in terms of UTI incidence as observed from the blood levels of leukocytes, C-reactive protein (CRP) and urine culture 3 days after the procedure. Results: Based on blood leukocyte levels, there was no statistically significant difference between the two groups (p = 0,74 and p = 0,42). So was the comparison of CRP levels. There was no other significant difference found (p = 0,53 and p = 0,27). From the results of urine culture, the ciprofloxacin group had positive urine culture results lower than the cefotaxime group (29,4% : 35,3%), although it was not statistically significant (p = 1,0). Conclusion: Based on the parameters of blood leukocytes levels, CRP and urine culture, there were no differences in the incidence of UTI after biopsy in the two groups.Keywords: TRUS prostate biopsy, UTI, ciprofloxacin, cefotaxime.

The Role of PCA3 Testing in Patients with a Raised Prostate-Specific Antigen Level After Greenlight Photoselective Vaporization of the Prostate

Greenlight(®) photoselective vaporization of the prostate (PVP) is an effective method for treating men with lower urinary tract symptoms. A rise in prostate specific antigen (PSA) levels, however, may be noticed in some patients during follow-up. The aim of this study was to determine whether the prostate cancer gene 3 (PCA3) urinary test would help identify patients who were in need of a prostate biopsy. The PSA of all patients undergoing PVP were analyzed. Patients with an elevated (above reference range) or rising PSA level (defined as > 0.75 ng/mL/year if the PSA was between 4.1 and 10 or a doubling time of less than 2 years) were offered a transrectal ultrasonography (TRUS) guided prostate biopsy. Before the biopsy procedure, all patients had a PCA3 test. The relationships between PSA, PCA3, and TRUS prostate biopsy findings were analyzed to determine sensitivity and specificity for the PCA3 test in this setting. 50 patients were identified. The mean age was 69.97 (range 57-83) years. The mean PSA level was 10.1 ng/mL (range 3.03-44.2 ng/mL). Six patients were found to have prostate cancer. Of those, five patients had a positive PCA3 test. One patient had a negative PCA3 test but positive biopsy findings. This gives a sensitivity of 83.3%, and a positive predictive value of 21.7%. The negative predictive value was 96%. The results suggest that a negative PCA3 test in our group of patients is a good predictor of negative biopsy results. The low positive predictive value may be an artefact of the group size. This will need further investigation and greater patient numbers to determine.

Prospective assessment of the efficacy of single dose versus traditional 3‐day antimicrobial prophylaxis in 12‐core transrectal prostate biopsy

To prospectively evaluate the efficacy of single dose antibiotic prophylaxis in 12-core transrectal ultrasonography (TRUS) guided prostate biopsy. A total of 400 patients who underwent prostate biopsy with TRUS guidance were included. The patients were prospectively randomized in three groups regarding antibiotic prophylaxis. The first group (139 patients) received a single gram of intramuscular ceftriaxone, while the second group (131 patients) had a 3-day course of oral ciprofloxacin. The third group (130 patients) had single oral 500 mg of ciprofloxacin. All patients had urine cultures prior to biopsy and on the second day after biopsy. The study groups were compared in terms of the results of urine cultures and clinical parameters. Overall, only seven patients (1.8% of the cases) had positive urine cultures with no difference between these three groups. Additionally, no significant difference was observed regarding morbidity rates in all groups. Only eight patients (2%) developed major complications requiring hospitalization. There was no increase in the rate of infectious complications when the biopsy core numbers were increased up to 12. The current study suggests that a single oral dose of antimicrobial prophylaxis is reasonable in TRUS prostate biopsy even in the case of 12-core sampling.