The effectiveness of targeted relative to empiric prophylaxis on infectious complications after transrectal ultrasound-guided prostate biopsy: a meta-analysis
- 245 Downloads
Rectal culture screening for fluoroquinolone (FQ)-resistant Enterobacteriaceae before transrectal ultrasound guided prostate (TRUSPB) biopsy and targeted antibiotic prophylaxis (TAP) may decrease post-TRUSPB infection rates compared to empiric (EAP) regimens. The objective of this study was to evaluate the effectiveness of targeted relative to empiric prophylaxis regimens on rates of infectious complications after TRUSPB and to determine the baseline prevalence of FQ resistance based on prior rectal swabs.
An electronic search within literature databases including EMBASE and Web of Science (all databases) for articles assessing TAP as an approach to TRUSPB prophylaxis was conducted. Quality assessment was performed using the Hoy instrument. Meta-analysis was performed using MetaXL 5.3.
From 15 studies (eight retrospective and seven prospective) representing 12,320 participants, infectious complication incidence was 3.4% in EAP and 0.8% in TAP patients. The number needed to treat with TAP to avoid one more infection when compared to the EAP group was 39. Effect sizes were homogeneous. Prevalence of FQ resistance showed low (15%) and high (28%) subgroups, likely due to region of origin (within and outside USA, respectively).
Rectal culture prior to TRUSPB and use of TAP adjusts for endemic FQ resistance and is associated with less infectious complications and resulting morbidity when compared to EAP. Overtreatment associated with augmented prophylaxis approaches may be reduced as a result. Further prospective assessment and cost–benefit analyses are required before widespread implementation can be recommended.
KeywordsFluoroquinolone resistance Prophylaxis Prostate biopsy Rectal culture Symptomatic infection
SE Scott: data collection, manuscript writing, and editing. PN Harris: manuscript editing and critical revisions & guidance. D Williamson: project development, manuscript editing, and critical revisions & guidance. MA Liss: manuscript editing and critical revisions & guidance. S.A.R Doi: project development, data analysis, and manuscript editing. MJ Roberts: project development, data collection and management, and manuscript writing and editing.
Compliance with ethical standards
Conflict of interest
All authors have no conflicts of interest to report.
This article does not contain any studies with human participants performed by any of the authors. Included studies report institutional ethical approval.
Informed consent was obtained where appropriate within the included manuscripts included in this study.
- 3.Grabe M, Bartoletti R, Bjerklund-Johansen TE et al (2014) Guidelines on urological infections. European Association of Urology (EAU), Arnhem. https://uroweb.org/wp-content/uploads/19-Urological-infections_LR2.pdf. Accessed 10 June 2017
- 8.Lahdensuo K, Rannikko A, Anttila VJ, Erickson A, Patari-Sampo A, Rautio M, Santti H, Tarkka E, Vaara M, Huotari K (2016) Increase of prostate biopsy-related bacteremic complications in southern Finland, 2005-2013: a population-based analysis. Prostate Cancer Prostatic Dis 19:417–422CrossRefPubMedGoogle Scholar
- 10.Wagenlehner FM, van Oostrum E, Tenke P, Tandogdu Z, Çek M, Grabe M, Wullt B, Pickard R, Naber KG, Pilatz A, Weidner W, Bjerklund-Johansen TE (2013) Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Eur Urol 63:521–527CrossRefPubMedGoogle Scholar
- 13.Roberts MJ, Williamson DA, Hadway P, Doi SAR, Gardiner RA, Paterson DL (2014) Baseline prevalence of antimicrobial resistance and subsequent infection following prostate biopsy using empirical or altered prophylaxis: a bias-adjusted meta-analysis. Int J Antimicrob Agents 43:301–309CrossRefPubMedGoogle Scholar
- 19.Higgins JPT, Green, S (2011) Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration Version 5.1.0Google Scholar
- 25.Doi SAR, Furuya-Kanamori L, Thalib L, Barendregt JJ (2017) Meta-analysis in evidence-based healthcare: a paradigm shift away from random effects is overdue. Int J Evid Based Healthc 15(4):152–160Google Scholar
- 31.Budak S, Karakece E, Budak GG, Aydemir H, Kumsar S, Kose O, Sencelikel T, Ciftci IH, Saglam HS, Adsan O (2015) Detection of fluoroquinolone-resistant bacteria prior to transrectal prostate biopsy: analysis of stool samples facilitates targeted prophylaxis. Acta Medica Mediterranea 31:275–279Google Scholar
- 33.Boeri L, Fontana M, Gallioli A, Zanetti SP, Catellani M, Longo F, Mangiarotti B, Montanari E (2017) Rectal culture-guided targeted antimicrobial prophylaxis reduces the incidence of post-operative infectious complications in men at high risk for infections submitted to transrectal ultrasound prostate biopsy -results of a cross-sectional study. PLoS ONE 12:e0170319CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Taylor AK, Zembower TR, Nadler RB, Scheetz MH, Cashy JP, Bowen D, Murphy AB, Dielubanza E, Schaeffer AJ (2012) Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol 187:1275–1279CrossRefPubMedGoogle Scholar
- 36.Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH, Loblaw DA, Trachtenberg J, Stanimirovic A, Simor AE, Seth A, Urbach DR, Narod SA (2013) Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 189:S12–S18CrossRefPubMedGoogle Scholar
- 42.Bonkat G, Pickard R, Bartoletti R, Bruyere F, Geerlings S, Wagenlehner F, Wullt B (2017) EAU guidelines. Urological infections. https://uroweb.org/guideline/urological-infections. Accessed 21 Sept 2017
- 43.Roberts MJ, Scott S, Harris PN, Naber K, Wagenlehner FME, Doi SAR (2017) Comparison of fosfomycin against fluoroquinolones for transrectal prostate biopsy prophylaxis: an individual patient-data meta-analysis. World J Urol (in press)Google Scholar