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Prostatabiopsie – Infektionsprophylaxe sowie Vorbereitung des Patienten

Prostate biopsy—infection prophylaxis and patient preparation

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Zusammenfassung

Die Prostatabiopsie steht aufgrund von hohen Infektionskomplikationen bei dem transrektalen Zugang und dem Lizenzentzug von Fluorchinolonen und Fosfomycin-Trometemol in der Prophylaxe die letzten Jahre im Zentrum des Umbruchs. Die Leitliniengruppe Urologische Infektionen der Europäischen Gesellschaft für Urologie (EAU) hat kürzlich eine Metaanalyse in zwei Teilen auf der Basis randomisiert kontrollierter Studien (RCT) veröffentlicht und aktualisiert die Daten jährlich für die EAU-Leitlinien. Die Metaanalysen zeigen, dass die transperineale Prostatabiopsie mit signifikant weniger Infektionskomplikationen assoziiert ist als die transrektale Biopsie und deswegen bevorzugt werden sollte. Wenn weiterhin die transrektale Biopsie zum Einsatz kommt, ist eine intrarektale Reinigung mit Povidon-Jod sowie eine antibiotische Prophylaxe zu verwenden. Als antibiotische Prophylaxe kommen die zielgerichtete Prophylaxe nach Empfindlichkeitstestung der Enddarmflora, die augmentierte Prophylaxe mit mehreren Antibiotika und die empirische Monoprophylaxe in Frage. Daten aus RCT liegen hier für Aminoglykoside und Cephalosporine der 3. Generation vor.

Abstract

Prostate biopsy has been at the center of controversy in recent years due to high infection complications associated with the transrectal route and the withdrawal of authorization for fluoroquinolones and fosfomycin trometemol as prophylaxis. The Urological Infections Guideline Group of the European Association of Urology (EAU) recently published a meta-analysis in two parts based on randomized controlled trials (RCTs) and annually updates the data for the EAU guidelines. The meta-analyses show that transperineal prostate biopsy is associated with significantly fewer infectious complications than transrectal biopsy and should therefore be preferred. If transrectal biopsy is still used, then intrarectal cleansing with povidone-iodine and antibiotic prophylaxis should be used. Antibiotic prophylaxis strategies include targeted prophylaxis after sensitivity testing of the rectal flora, augmented prophylaxis with several antibiotics and empirical monoprophylaxis. Data from RCTs are available for aminoglycosides and third-generation cephalosporins.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland

    A. Pilatz, J. Alidjanov & F. Wagenlehner

  2. alta uro AG, Basel, Schweiz

    G. Bonkat

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  1. A. Pilatz
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  2. J. Alidjanov
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  3. G. Bonkat
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  4. F. Wagenlehner
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Correspondence to A. Pilatz.

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Interessenkonflikt

A. Pilatz, J. Alidjanov, G. Bonkat und F. Wagenlehner geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Pilatz, A., Alidjanov, J., Bonkat, G. et al. Prostatabiopsie – Infektionsprophylaxe sowie Vorbereitung des Patienten. Urologie 62, 459–463 (2023). https://doi.org/10.1007/s00120-023-02065-w

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  • DOI: https://doi.org/10.1007/s00120-023-02065-w

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