Comparison of Single and Prolonged Fluoroquinolone Prophylaxis and Risk Factors for Infectious Complications After Transrectal Prostate Biopsy

• Published in: Balkan medical journal Vol. 35; no. 5; pp. 373 - 377
• Main Authors: Kalkanlı, Arif, Gezmiş, Cem Tuğrul, Özkan, Arif, Çilesiz, Nusret Can, Yanaral, Fatih, Aydın, Memduh, Tandoğdu, Zafer
• Format: Journal Article
• Language: English
• Published: Turkey Galenos Yayinevi Tic. Ltd 01-09-2018; Trakya Üniversitesi; Aves Yayincilik Ltd. STI; Galenos Publishing; Galenos Publishing House
• Subjects: Aged; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis - methods; Antibiotics; Antimicrobial agents; Biopsy; Comparative analysis; Complications; Complications and side effects; Dosage and administration; Drug resistance; fluoroquinolone; Fluoroquinolones - administration & dosage; Hospitals; Humans; Image-Guided Biopsy - adverse effects; Image-Guided Biopsy - methods; Intubation; Male; Medical research; Middle Aged; Original; Patients; Postoperative Complications - etiology; Postoperative Complications - prevention & control; prophylaxis; Prospective Studies; Prostate; Prostate - pathology; Prostate - surgery; Prostate cancer; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Quinolone antibacterial agents; Quinolones; Rectum - surgery; Risk Factors; Sepsis; Surgery; Tıp; Treatment Outcome; Ultrasonic imaging; Ultrasonography, Interventional - adverse effects; Ultrasonography, Interventional - methods; Urinalysis; Urinary tract diseases; Urinary tract infections; Urinary Tract Infections - etiology; Urinary Tract Infections - prevention & control; Urine; Urogenital system; Urology; Türkiye; Edirne; Turkey; prostate; Biopsy; fluoroquinolone; prophylaxis; urinary tract infections
• ISSN: 2146-3123; 2146-3131
• DOI: 10.4274/balkanmedj.2018.0477

The ideal prophylaxis duration for transrectal ultrasonography-guided prostate biopsy is incompletely defined.
To compare the infectious complications of transrectal ultrasonography-guided prostate biopsy with and without extended antibiotic prophylaxis. The secondary aim was to evaluate the risk factors for infectious complications.
Prospective observational study.
Four hundred patients who underwent transrectal ultrasonography-guided prostate biopsy were recruited. Patients orally received either 750 mg ciprofloxacin 60 min before the procedure or 500 mg ciprofloxacin twice a day for a duration of 7 days with the initial dose administered 24 h prior to the procedure. All patients were followed-up for 4 weeks after the transrectal ultrasonography-guided prostate biopsy procedure for infectious complications. Screening of urine was carried out in all patients on the 3
and 7
day after the procedure. Medical histories of all patients were collected prior to biopsy. Information on medical history include the following: hospitalization, urethral catheterization, or urinary tract infections within the past 12 months; antibiotic use within the last 3 months, prior urinary tract interventions, and previous transrectal ultrasonography-guided prostate biopsy and Charlson comorbidity indexes. Ultrasound-guided biopsy was carried out using General Electric’s 7 MHz transrectal ultrasound device in the left decubitus position. Patients received one of the two ciprofloxacin-based prophylaxis regimens. Subsequent transrectal ultrasonography-guided prostate biopsy to all patients were followed-up for 30 days. Further follow-up of patients was carried out on the second and fourth weeks after transrectal ultrasonography-guided prostate biopsy, and symptoms, such as dysuria, rectal bleeding, fever, hematospermia, hematuria, and pollakiuria, were recorded.
Both groups presented similar baseline characteristics and medical history. Infectious complication rates within the 4-week follow-up were similar in both groups (single dose: 3% vs prolonged: 3%) (p>0.05). In both groups, infectious complications significantly increased than that at previous antibiotic usage (single: p=0.028; prolonged: p=0.040). Non-infectious complication ratios showed no significant variation (p>0.05).
Pre-operative single dose of 750 mg oral ciprofloxacin compared with 7 days prolonged treatment resulted in similar infectious complication outcomes in patients undergoing transrectal ultrasonography-guided prostate biopsy. The use of antibiotics within the last 3 months increases the risk for post-transrectal ultrasonography-guided prostate biopsy infectious complications.