Department of Urology, St. Infectious complications after transrectal ultrasound-guided prostate biopsy TRUS-Bx appear to be increasing, which reflects the high prevalence of antibiotic-resistant strains of Enterobacteriaceae. Dopo TRUS prostata patients at high risk for antibiotic resistance with history taking is an important initial step. Dopo TRUS prostata prophylaxis with a prebiopsy rectal swab culture or augmented antibiotic prophylaxis can be considered for patients at high risk of antibiotic resistance.
If infectious complications are suspected, the presence of urosepsis should be evaluated and adequate antibiotic dopo TRUS prostata should be started immediately. Transrectal ultrasound-guided prostate biopsy TRUS-Bx is dopo TRUS prostata of the most dopo TRUS prostata performed urologic procedures in the United States and Europe, with approximately one million biopsies performed annually on each continent.
TRUS-Bx is a relatively safe procedure and the chances of severe complications are low, but the incidence of infectious complications has recently been rising, along with the potential for more severe complications such as sepsis [ dopo TRUS prostata2 ].
Randomized controlled trials have shown that antibiotic prophylaxis is effective in preventing infectious complications following TRUS-Bx [ 7 ].
Fluoroquinolone is the most commonly used antibiotic agent for prophylaxis [ 78 ]. However, worldwide antibiotic resistance is rising [ 910dopo TRUS prostata ], and as such, dopo TRUS prostata complications after TRUS-Bx by fluoroquinolone-resistant E.
In another Asia-Europe multicenter study that included Korea, the reported incidence of febrile urinary tract infection UTI was 3. In Japan, the reported incidence of febrile UTI was from 0. In a study that analyzed complications after prostate biopsy from SEER Surveillance, Epidemiology and End Results -Medicare data from toinfectious complications after prostate biopsy increased in dopo TRUS prostata years [ 1 ]. Dopo TRUS prostata a Canadian report, the incidence of dopo TRUS prostata complications that required admission was 1.
Another recent Canadian report also stated that the incidence of infectious complications was 0. The main reason for this increase in infectious complications is the rise in fluoroquinolone resistance [ 9 ]. In a Japanese study, acute bacterial prostatitis developed in 1. In another Japanese study, the rate of genitourinary tract infection was 0. In a North American cohort, 2. In a French prospective study, 0. In an Australian study that analyzed E.
Along with the problem of fluoroquinolone resistance, one should also be wary of the emergence of extended-spectrum beta-lactamase ESBL -producing bacteria.
Investigators from the United States [ 12 ] and Japan [ 30 ] monitored the rates of fluoroquinolone-resistant E. The purpose of monitoring for fluoroquinolone-resistant E. Targeted prophylaxis may not only prevent infectious complications and sepsis after TRUS-Bx but also suppress the rise of antibiotic-resistant bacteria. In a study conducted to evaluate targeted antibiotic prophylaxis in men undergoing TRUS-Bx in the United States, there were no infectious complications in the men who received targeted antibiotic prophylaxis, whereas there were 9 cases including 1 of sepsis among the men on empirical therapy [ 31 ].
However, debate remains as to whether rectal dopo TRUS prostata cultures should be routinely performed before TRUS-Bx. In a Canadian study, despite a significant correlation between patients who dopo TRUS prostata infections and the detection of ciprofloxacinresistant organisms, only 9. Future studies will need to evaluate the cost effectiveness and clinical utility of a prebiopsy rectal culture in targeted antibiotic prophylaxis [ 32 ].
Fluoroquinolone use in the previous 3 to 6 months prior to TRUS-Bx was a common risk factor for fluoroquinolone resistance in several studies [ 5333435 ]. The longer the period of fluoroquinolone use, the higher the incidence of fluoroquinolone resistance [ 35 ].
Therefore, thorough history taking is of paramount importance for identifying recent fluoroquinolone usage for other conditions such as UTI, chronic prostatitis, heart valve surgery, and artificial instrument insertion surgery Fig. However, in cases of a high risk of fluoroquinolone resistance, performing prebiopsy rectal swab culture to identify rectal bacterial flora would be of great assistance in preventing or treating infectious complications.
If the patient has a history of recent antibiotic use, however, prebiopsy rectal swab culture should be postponed or its results should be interpreted cautiously.
Targeted antibiotic prophylaxis dopo TRUS prostata on rectal swab culture results showed a notable decrease in the incidence of infectious complications after TRUS-Bx caused by fluoroquinolone-resistant organisms as well as a decrease in the overall cost of care [ 31 ].
However, in regions such as Korea where the rate of fluoroquinolone resistance is high, following the US and European guidelines may be less effective for antibiotic prophylaxis. If prebiopsy rectal swab culture is done, susceptible dopo TRUS prostata agents should be used, and if it is not done, prophylactic antibiotic agents should be changed in patients suspected of fluoroquinolone resistance. For dopo TRUS prostata, attempts have been made to add dopo TRUS prostata aminoglycoside such as amikacin to fluoroquinolone or to dopo TRUS prostata third-generation cephalosporins for prophylaxis.
However, this may cause another problem in addition to fluoroquinolone resistance: emergence of ESBL-producing bacteria. ESBL-producing bacteria are usually resistant to most antibiotics with the exception of carbapenems imipenem, meropenem. Because infectious complications af ter TRUS-Bx could be fatal, immediate admission and implementation of antibiotics is warranted in cases suspected of sepsis. If a prebiopsy rectal swab culture is done, a susceptible antibiotic agent targeting the suspected causative bacteria should be used.
If not, third-generation cephalosporins and aminoglycoside may be the optimal choice, at least in Korea [ 25 ]. Because resistance to gentamicin and tobramycin is already high in Korea, amikacin is the recommended aminoglycoside.
If ESBL-producing bacteria are suspected or cephalosporins are ineffective, use of carbapenems such as dopo TRUS prostata or meropenem should not be delayed.
Once the results of the antibiotic susceptibility test are confirmed, de-escalation therapy is recommended, which consists of switching from a broad-spectrum empiric antibiotic therapy to a narrower spectrum. After the patient is discharged, continued treatment for a sufficient period of time dopo TRUS prostata necessary to cure prostatitis. Infectious complications after TRUS-Bx are increasing, and this appears to be due to an increasing prevalence of floroquinolone-resistant strains in the rectal flora.
Therefore, identifying the risk for fecal carriage of floroquinolone-resistant strains by history taking should be the initial step in the TRUS-Bx procedure.
If a risk of fluoroquinolone resistance dopo TRUS prostata present, targeted antimicrobial prophylaxis using rectal swab cultures or alternative antibiotics may be recommended for prophylaxis.
In patients with infectious complications after TRUS-Bx, it is essential to administer appropriate antibiotics immediately. National Center for Biotechnology InformationU. Journal List Korean J Urol v. Korean J Urol. Published online Apr 6. Seung-Ju Lee. Find articles by Seung-Ju Lee. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Corresponding Author: Seung-Ju Lee.
Received Jan 2; Accepted Mar This article has been cited by other articles in PMC. Abstract Infectious complications after transrectal ultrasound-guided prostate biopsy TRUS-Bx appear to be increasing, which reflects the high prevalence of antibiotic-resistant strains of Enterobacteriaceae. Keywords: Biopsy, Infection, Prostate.
Identifying high-risk patients with history taking Fluoroquinolone use in the previous 3 to 6 months prior dopo TRUS prostata TRUS-Bx was a common risk factor for fluoroquinolone resistance in several studies [ 5333435 ]. Open in a separate window. Flow chart to choose antibiotic prophylaxis for transrectal prostate biopsy. Targeted antibiotic dopo TRUS prostata The evidence for routine rectal swab culture before all TRUS-Bx is still indeterminate.
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