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Chemoprophylaxis during transrectal prostate needle biopsy: critical analysis through randomized clinical trial

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Abstract

Purpose

To compare the efficacy of three chemoprophylaxis approaches in prevention of post-transrectal biopsy infectious complications (TBICs).

Methods

Patients were randomly assigned to receive ciprofloxacin 3 days 500 mg B.I.D 3 days starting the night prior to biopsy (standard prophylaxis), augmented prophylaxis using ciprofloxacin and single preprocedure shot of 160 mg gentamicin IM (augmented prophylaxis) and rectal swab culture-based prophylaxis (targeted prophylaxis). Patients were assessed 2 weeks prior to biopsy, at biopsy and 2 weeks after. Primary end point was occurrence of post-TBICs that included simple UTI, febrile UTI or sepsis. Secondary end points were post-biopsy change in the inflammatory markers (TLC, ESR and CRP), unplanned visits, hospitalization and occurrence of fluoroquinolones resistance (FQ-R; bacterial growth on MacConkey agar plate with 10 μg/ml ciprofloxacin) in the fecal carriage of screened men.

Results

Between April/2015 and January/2017, standard, augmented and targeted prophylaxes were given to 163, 166 and 167 patients, respectively. Post-TBICs were reported in 43 (26%), 13 (7.8%) and 34 (20.3%) patients following standard, augmented and targeted prophylaxes protocols, respectively (P = 0.000). Post-TBICs included UTI in 23 (4.6%), febrile UTI in 41 (8.2%) and sepsis in 26 (5.2%) patients. Significantly lower number of post-biopsy positive urine culture was depicted in the augmented group (P = 0.000). The number of biopsy cores was statistically different in the three groups (P = 0.004). On multivariate analysis, augmented prophylaxis had independently lower post-TBICs (OR 0.2, 95% CI 0.1–0.4, P = 0.000) when compared with the other two groups regardless of the number of biopsy cores taken (OR 1.07, 95% CI 0.95–1.17, P = 0.229). Post-biopsy hospitalization was needed in four (2%), one (0.6%) and ten (6%) patients following standard, augmented and targeted prophylaxes, respectively (P = 0.014). However, sepsis-related hospitalization was not statistically different. Post-biopsy changes in the inflammatory markers were significantly less in augmented prophylaxis (P < 0.05). FQ-R was depicted in 139 (83.2%) of the screened men.

Conclusion

Augmented prophylaxis with single-dose gentamicin is an effective and practical approach. Targeted prophylaxis might be reserved for cases with contraindication to gentamicin.

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Abbreviations

RCT:

Randomized controlled trial

UTI:

Urinary tract infection

TRUS:

Transrectal ultrasound

TRUSPB:

Transrectal ultrasound-guided prostate biopsy

TBIC:

TRUS biopsy infection complications

TBNIC:

TRUS biopsy non-infection complications

SIRS:

Systemic inflammatory response syndrome

FQ-R:

Fluoroquinolone resistance

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Authors and Affiliations

  1. Prostate Unit, Urology Department, Urology and Nephrology Center, Mansoura University, El Gomhoria Street, Mansoura, DK, 35516, Egypt

    Ahmed M. Elshal, Ahmed M. Atwa, Ahmed R. El-Nahas, Abdelwahab Hashem, Hossam Nabeeh & Ahmed Mosbah

  2. Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, DK, Egypt

    Mohamed A. El-Ghar, Hashim Farg, Ali Elsorougy & Mohamed Fouda

  3. Microbiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, DK, Egypt

    Asaad Gaber, Essam Elsawy & Yasser Farag

Authors
  1. Ahmed M. Elshal
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  2. Ahmed M. Atwa
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  3. Ahmed R. El-Nahas
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  4. Mohamed A. El-Ghar
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  6. Essam Elsawy
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  7. Abdelwahab Hashem
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  8. Yasser Farag
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  9. Hashim Farg
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  11. Mohamed Fouda
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  12. Hossam Nabeeh
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Contributions

AME: protocol/project development, data analysis, manuscript writing/editing. AMA: data collection or management. ARE-N: manuscript writing/editing. MAE-G: data analysis. AG: microbiology workup. EE: microbiology workup, data analysis. AH: data collection or management. YF: microbiology workup. HF: prostate biopsy/radiology reporting. AE: prostate biopsy/radiology reporting. MF: prostate biopsy/radiology reporting. HN: data collection or management. AM: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to Ahmed M. Elshal.

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The authors declare that they have no competing interests.

Research involving human participants and/or animals

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Elshal, A.M., Atwa, A.M., El-Nahas, A.R. et al. Chemoprophylaxis during transrectal prostate needle biopsy: critical analysis through randomized clinical trial. World J Urol 36, 1845–1852 (2018). https://doi.org/10.1007/s00345-018-2319-2

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  • DOI: https://doi.org/10.1007/s00345-018-2319-2

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