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The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography-guided prostate biopsy in reducing infection rates: a systematic review

The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography-guided prostate biopsy in reducing infection rates: a systematic review
The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography-guided prostate biopsy in reducing infection rates: a systematic review

To compare the incidence of infective complications after transrectal ultrasonography (TRUS)-guided biopsy with either empirical fluoroquinolone or culture-based targeted antimicrobial prophylaxis, and the prevalence of fluoroquinolone resistance (FQ-R) in men undergoing prostate biopsy. A systematic review of the literature was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included studies of patients undergoing TRUS-guided biopsy that compared infective outcomes of those who received targeted antimicrobial therapy based on the results of pre-procedural rectal swab cultures, with those receiving empiric fluoroquinolone antimicrobial prophylaxis. The prevalence of FQ-R was recorded as a secondary outcome measure. Studies with no control group were excluded. From 125 studies screened, nine studies (4 571 patients) met the inclusion criteria. All studies were of cohort design, and included a combination of retrospective and prospective data. Six studies included were undertaken in North America. The remaining studies were undertaken in Spain, Turkey and Columbia. Within these studies, 2 484 (54.3%) patients received empirical fluoroquinolone prophylaxis, whilst 2 087 (45.7%) patients had pre-biopsy rectal swabs and targeted antibiotics. The mean FQ-R was 22.8%. Post-biopsy infection and sepsis rates were significantly higher in groups given empirical prophylaxis (4.55% and 2.21%) compared with groups receiving targeted antibiotics (0.72% and 0.48%). Based on these results 27 men would need to receive targeted antibiotics to prevent one infective complication. Our systematic review suggests that targeted prophylactic antimicrobial therapy before TRUS-guided prostate biopsy is associated with lower rates of sepsis. We therefore recommend changing current pathways to adopt this measure.

Anti-Infective Agents, Antibiotic Prophylaxis, Drug Resistance, Microbial, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Fluoroquinolones, Humans, Infection, Male, Prevalence, Prostate, Prostatic Neoplasms, Journal Article, Review
1464-4096
725-731
Cussans, Amelia
b7c76d5f-6743-44b8-915e-5c44b9ebbfdf
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Basarab, Adriana
f48d3d40-b406-4168-8705-cb9f3e33f64b
Dudderidge, Timothy J
dae51cb9-9192-4352-9d7e-c7b2fcc4031a
Cussans, Amelia
b7c76d5f-6743-44b8-915e-5c44b9ebbfdf
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Basarab, Adriana
f48d3d40-b406-4168-8705-cb9f3e33f64b
Dudderidge, Timothy J
dae51cb9-9192-4352-9d7e-c7b2fcc4031a

Cussans, Amelia, Somani, Bhaskar K, Basarab, Adriana and Dudderidge, Timothy J (2016) The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography-guided prostate biopsy in reducing infection rates: a systematic review. BJU International, 117 (5), 725-731. (doi:10.1111/bju.13402).

Record type: Review

Abstract

To compare the incidence of infective complications after transrectal ultrasonography (TRUS)-guided biopsy with either empirical fluoroquinolone or culture-based targeted antimicrobial prophylaxis, and the prevalence of fluoroquinolone resistance (FQ-R) in men undergoing prostate biopsy. A systematic review of the literature was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included studies of patients undergoing TRUS-guided biopsy that compared infective outcomes of those who received targeted antimicrobial therapy based on the results of pre-procedural rectal swab cultures, with those receiving empiric fluoroquinolone antimicrobial prophylaxis. The prevalence of FQ-R was recorded as a secondary outcome measure. Studies with no control group were excluded. From 125 studies screened, nine studies (4 571 patients) met the inclusion criteria. All studies were of cohort design, and included a combination of retrospective and prospective data. Six studies included were undertaken in North America. The remaining studies were undertaken in Spain, Turkey and Columbia. Within these studies, 2 484 (54.3%) patients received empirical fluoroquinolone prophylaxis, whilst 2 087 (45.7%) patients had pre-biopsy rectal swabs and targeted antibiotics. The mean FQ-R was 22.8%. Post-biopsy infection and sepsis rates were significantly higher in groups given empirical prophylaxis (4.55% and 2.21%) compared with groups receiving targeted antibiotics (0.72% and 0.48%). Based on these results 27 men would need to receive targeted antibiotics to prevent one infective complication. Our systematic review suggests that targeted prophylactic antimicrobial therapy before TRUS-guided prostate biopsy is associated with lower rates of sepsis. We therefore recommend changing current pathways to adopt this measure.

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More information

e-pub ahead of print date: 28 December 2015
Published date: May 2016
Additional Information: © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.
Keywords: Anti-Infective Agents, Antibiotic Prophylaxis, Drug Resistance, Microbial, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Fluoroquinolones, Humans, Infection, Male, Prevalence, Prostate, Prostatic Neoplasms, Journal Article, Review

Identifiers

Local EPrints ID: 419249
URI: https://eprints.soton.ac.uk/id/eprint/419249
ISSN: 1464-4096
PURE UUID: fd649eea-0db8-4f19-b563-e421798e4157

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Date deposited: 09 Apr 2018 16:30
Last modified: 13 Mar 2019 18:44

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