155 Is targeted antibiotic prophylaxis for transrectal prostate biopsy based on rectal swab cultures still effective to prevent infective complications?

155

Is targeted antibiotic prophylaxis for transrectal prostate biopsy based on rectal swab cultures still effective to prevent infective complications? Eur Urol Suppl 2016;15(3);e155          

Print! Print!

Nasu Y. 1 , Murata T.1 , Kosaka N.2 1 Okayama

Rosai Hospital, Dept. of Urology, Okayama, Japan, 2 Okayama Rosai Hospital, Dept. of Clinical Laboratory, Okayama, Japan

INTRODUCTION & OBJECTIVES: Recently there were several reports of an increase in Infective Complications (IC) after Transrectal ultrasonography guided Prostate Biopsy (TRPB) due to Quinolone-Resistant (QR) or Extended Spectrum Beta-Lactamase (ESBL) producing strains. The targeted antibiotic prophylaxis, which chose appropriate susceptible antibiotics for prophylaxis based on the rectal swab culture, has been reported to be effective for prevention of IC. We evaluated the prevalent rate of resistant strains in rectal flora and the efficacy of targeted antibiotic prophylaxis for prevention of IC after TRPB among patients with QR strains. MATERIAL & METHODS: From January 2010 to September 2015, a total of 331 men who underwent TRPB were included. Prior to TRPB, rectal swabs were cultured and determined the possession of resistant strain in their rectal flora. Isolated bacteria was deemed QR when its minimum inhibitory concentration of levofloxacin (LVFX) was 4 μg/mL or above. ESBL producing ability was determined by double disk method. For male patients without the possession of QR strains, single oral 500mg of LVFX was received 2 hours before TRPB. While patients with QR strains received intramuscular or intravenous formulations of antibiotics for which the isolates were susceptible. All biopsy was carried out through a standard 10-core approach with local anesthesia. Patients were followed up for 2 weeks after TRPB and febrile IC were recorded. RESULTS: Overall the prevalent rate of QR and ESBL producing strains was 13.6% (45/331) and 6.0% (20/331), respectively. In the first half of the study period (January 2010 to March 2013), the prevalent rate of QR and ESBL producing strains was 9.7% (17/176) and 3.4% (6/175), respectively. That of the last half (April 2013 to September 2015) was 18.1% (28/155) and 9.0% (14/155), respectively. The prevalent rate of QR and ESBL producing strains was significantly increased in the last half period (Fisher′s exact test, p<0.05). A total of 14 patients had post-TRPB fever in this study and the over-all incidence of febrile IC was 4.22%. In the first half period, the incidence of febrile IC was 1.7% (3/176) and that of the last half period was 7.1% (11/155). The incidence of febrile IC was increasing in the last half period (Fisher′s exact test, p<0.05). Forty-five patients with QR strains were complied with targeted antibiotic prophylaxis. In the first half period, only one patient out of 17 patients with QR strains had febrile IC. In the last half period, although they received antibiotics which were susceptible to isolates from rectal swab cultures, 8 out of 28 patients with QR strains had febrile IC. CONCLUSIONS: In the first half period (January 2010 to March 2013), we experienced few patients with febrile IC both quinolone-sensitive and QR strain group.  In the last half period (April 2013 to September 2015), the incidence of febrile IC was increasing, especially among patients with QR strains. Although, LVFX has been still effective for quinolone-sensitive patient group in the last half period, the targeted antibiotic prophylaxis based on rectal swab cultures was less effective among patients with QR strains.  Facing the increase of multi-drug resistant bacteria, new tactics for prevention of post-TRPB febrile IC among patients with QR srains will be needed.