Skip to main content
SpringerLink
Log in

Antimicrobial prophylaxis protocol based on rectal swab culture before prostate biopsy to prevent infectious complications: a prospective randomized comparative study

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the benefit of targeted antibiotic prophylaxis (TAP) based on rectal swab culture in comparison with standard empiric antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided needle biopsy of the prostate (TRUS-BP), as well as to assess rate of fecal carriage of Fluoroquinolone-resistant Enterobacterales FQRE.

Patients and methods

We prospectively analyzed data that randomized 157 patients within two groups: (G1) TAP according to rectal swab performed 10 days before PB; (G2): empirical antibiotic prophylaxis with ciprofloxacin. Prevalence of FQRE digestive carriage and risk factors were investigated. Incidence of infectious complications after (TRUS-BP) in each group was compared.

Results

G2 included 80 patients versus 77 in G1. There was no difference between the two groups regarding age, diabetes, prostate volume, PSA, number of biopsy cores, and risk factors for FQRE. In G2, the prevalence of FQRE digestive carriage was 56.3% all related to E. coli species. In the case of digestive carriage of FQRE, TAP according to the rectal swab culture with third-generation cephalosporins was performed in 73.3%. Patients with FQRE had history of FQ use within the last 6 months in 17.8% (p = 0.03). Rate of febrile urinary tract infection after PB was 13% in G1 and 3.8% in G2 (p = 0.02).

Conclusions

Incidence of FQ resistance in the intestinal flora of our local population was prevalent. Risk factor for resistance was the use of FQ within the last 6 months. TAP adapted to rectal swab, mainly with third-generation cephalosporins, significantly reduced the rate of infectious complications after (TRUS-BP).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492

    Article  PubMed  Google Scholar 

  2. Raaijmakers R, Kirkels WJ, Roobol MJ, Wildhagen MF, Schrder FH (2002) Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology 60(5):826–830. https://doi.org/10.1016/s0090-4295(02)01958-1

    Article  PubMed  Google Scholar 

  3. Bootsma AM, Laguna Pes MP, Geerlings SE, Goossens A (2008) Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol 54(6):1270–1286. https://doi.org/10.1016/j.eururo.2008.03.033

    Article  PubMed  Google Scholar 

  4. Akduman B, Akduman D, Tokgöz H, Erol B, Türker T, Ayoğlu F, Mungan NA (2011) Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms. Urology 78(2):250–255. https://doi.org/10.1016/j.urology.2011.02.065

    Article  PubMed  Google Scholar 

  5. Ozden E, Bostanci Y, Yakupoglu KY, Akdeniz E, Yilmaz AF, Tulek N, Sarikaya S (2009) Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy. Urology 74(1):119–123. https://doi.org/10.1016/j.urology.2008.12.067

    Article  PubMed  Google Scholar 

  6. Liss MA, Taylor SA, Batura D, Steensels D, Chayakulkeeree M, Soenens C, Rao GG, Dash A, Park S, Patel N, Woo J, McDonald M, Nseyo U, Banapour P, Unterberg S, Ahlering TE, Van Poppel H, Sakamoto K, Fierer J, Black PC (2014) Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy. J Urol 192(6):1673–1678. https://doi.org/10.1016/j.juro.2014.06.005

    Article  PubMed  Google Scholar 

  7. Taylor S, Margolick J, Abughosh Z, Goldenberg SL, Lange D, Bowie WR, Bell R, Roscoe D, Machan L, Black P (2013) Ciprofloxacin resistance in the faecal carriage of patients undergoing transrectal ultrasound guided prostate biopsy. BJU Int 111(6):946–953. https://doi.org/10.1111/j.1464-410X.2012.11637.x

    Article  CAS  PubMed  Google Scholar 

  8. Wagenlehner FM, Pilatz A, Waliszewski P, Weidner W, Johansen TE (2014) Reducing infection rates after prostate biopsy. Nat Rev Urol 11(2):80–86. https://doi.org/10.1038/nrurol.2013.322

    Article  PubMed  Google Scholar 

  9. Summers SJ, Patel DP, Hamilton BD, Presson AP, Fisher MA, Lowrance WT, Southwick AW (2015) An antimicrobial prophylaxis protocol using rectal swab cultures for transrectal prostate biopsy. World J Urol 33(12):2001–2007. https://doi.org/10.1007/s00345-015-1571-y

    Article  PubMed  Google Scholar 

  10. Holmbom M, Forsberg J, Fredrikson M, Nilsson M, Nilsson LE, Hanberger H, Hällgren A (2023) Fluoroquinolone-resistant Escherichia coli among the rectal flora is the predominant risk factor for severe infection after transrectal ultrasound-guided prostate biopsy: a prospective observational study. Scand J Urol 8(58):32–37. https://doi.org/10.2340/sju.v58.11920

    Article  Google Scholar 

  11. Benli E, Yuce A, Cirakoglu A, Yazici I, Kadim N, Nalbant I (2022) Effect of targeted prophylaxis with rectal swab on complications after prostate biopsy: prospective randomized study. Ir J Med Sci 191(3):1147–1152. https://doi.org/10.1007/s11845-021-02723-y

    Article  CAS  PubMed  Google Scholar 

  12. Naber KG, Sörgel F (2003) Antibiotic therapy–rationale and evidence for optimal drug concentrations in prostatic and seminal fluid and in prostatic tissue. Andrologia 35(5):331–335

    Article  CAS  PubMed  Google Scholar 

  13. Kapoor DA, Klimberg IW, Malek GH, Wegenke JD, Cox CE, Patterson AL, Graham E, Echols RM, Whalen E, Kowalsky SF (1998) Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy. Urology 52(4):552–558. https://doi.org/10.1016/s0090-4295(98)00296-9

    Article  CAS  PubMed  Google Scholar 

  14. G. Bonkat (Chair), R. Bartoletti, F. Bruyère, T. Cai, S.E. Geerlings, B. Köves, S. Schubert, F. Wagenlehner, Guidelines Associates: T. Mezei, A. Pilatz, B. Pradere, R. Veeratterapillay . EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam the Netherlands 2020. ISBN 978–94–92671–07–3.

  15. Zaytoun OM, Vargo EH, Rajan R, Berglund R, Gordon S, Jones JS (2011) Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment. Urology 77(5):1035–1041. https://doi.org/10.1016/j.urology.2010.12.067

    Article  PubMed  Google Scholar 

  16. Wagenlehner F, Stöwer-Hoffmann J, Schneider-Brachert W, Naber KG, Lehn N (2000) Influence of a prophylactic single dose of ciprofloxacin on the level of resistance of Escherichia coli to fluoroquinolones in urology. Int J Antimicrob Agents 15(3):207–211. https://doi.org/10.1016/s0924-8579(00)00182-5

    Article  CAS  PubMed  Google Scholar 

  17. 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(4):1275–1279. https://doi.org/10.1016/j.juro.2011.11.115

    Article  CAS  PubMed  Google Scholar 

  18. Duplessis CA, Bavaro M, Simons MP, Marguet C, Santomauro M, Auge B, Collard DA, Fierer J, Lesperance J (2012) Rectal cultures before transrectal ultrasound-guided prostate biopsy reduce post-prostatic biopsy infection rates. Urology 79(3):556–561. https://doi.org/10.1016/j.urology.2011.09.057

    Article  PubMed  Google Scholar 

  19. Liss MA, Chang A, Santos R, Nakama-Peeples A, Peterson EM, Osann K, Billimek J, Szabo RJ, Dash A (2011) Prevalence and significance of fluoroquinolone resistant Escherichia coli in patients undergoing transrectal ultrasound guided prostate needle biopsy. J Urol 185(4):1283–1288. https://doi.org/10.1016/j.juro.2010.11.088

    Article  PubMed  PubMed Central  Google Scholar 

  20. Suwantarat N, Dumford DM 3rd, Ponce-Terashima R, Kundrapu S, Zabarsky TF, Zhu H, Donskey CJ (2013) Modification of antimicrobial prophylaxis based on rectal culture results to prevent fluoroquinolone-resistant Escherichia coli infections after prostate biopsy. Infect Control Hosp Epidemiol 34(9):973–976. https://doi.org/10.1086/671734

    Article  PubMed  Google Scholar 

  21. Dai J, Leone A, Mermel L, Hwang K, Pareek G, Schiff S, Golijanin D, Renzulli JF 2nd (2015) Rectal swab culture-directed antimicrobial prophylaxis for prostate biopsy and risk of postprocedure infection: a cohort study. Urology 85(1):8–14. https://doi.org/10.1016/j.urology.2014.09.035

    Article  PubMed  Google Scholar 

  22. Tsu JH, Ma WK, Chan WK, Lam BH, To KC, To WK, Ng TK, Liu PL, Cheung FK, Yiu MK (2015) Prevalence and predictive factors of harboring fluoroquinolone-resistant and extended-spectrum β-lactamase-producing rectal flora in Hong Kong Chinese men undergoing transrectal ultrasound-guided prostate biopsy. Urology 85(1):15–21. https://doi.org/10.1016/j.urology.2014.07.078

    Article  PubMed  Google Scholar 

  23. Piekarska K, Zacharczuk K, Wołkowicz T, Mokrzyś M, Wolaniuk N, Nowakowska M, Szempliński S, Dobruch J, Gierczyński R (2021) The molecular mechanisms of fluoroquinolone resistance found in rectal swab isolates of Enterobacterales from men undergoing a transrectal prostate biopsy: the rationale for targeted prophylaxis. Ann Clin Microbiol Antimicrob 20(1):81. https://doi.org/10.1186/s12941-021-00487-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Tekdoğan Ü, Tuncel A, Eroğlu M, Ünsal A, Atan A, Balbay MD (2006) The efficiency of prophylactic antibiotic treatment in patients without risk factor who underwent transrectal. Türk Üroloji Dergisi 32(2):261–267

    Google Scholar 

  25. Wang H, Zhou X, Chen S, Zhu C, Yu X (2004) Investigation of infection risk and the value of antibiotic prophylaxis during transrectal biopsy of the prostate by endotoxin determination. Zhonghua Nan Ke Xue 10(7):496–498

    CAS  PubMed  Google Scholar 

  26. Kehinde EO, Al-Maghrebi M, Sheikh M, Anim JT (2013) Combined ciprofloxacin and amikacin prophylaxis in the prevention of septicemia after transrectal ultrasound guided biopsy of the prostate. J Urol 189(3):911–915. https://doi.org/10.1016/j.juro.2012.08.237

    Article  CAS  PubMed  Google Scholar 

  27. Adibi M, Hornberger B, Bhat D, Raj G, Roehrborn CG, Lotan Y (2013) Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic prophylaxis. J Urol 189(2):535–540. https://doi.org/10.1016/j.juro.2012.08.194

    Article  PubMed  Google Scholar 

  28. Song W, Choo SH, Sung HH, Han DH, Jeong BC, Seo SI, Jeon SS, Lee KS, Lee SW, Lee HM, Choi HY, Jeon HG (2014) Incidence and management of extended-spectrum beta-lactamase and quinolone-resistant Escherichia coli infections after prostate biopsy. Urology 84(5):1001–1007. https://doi.org/10.1016/j.urology.2014.06.052

    Article  PubMed  Google Scholar 

  29. Tukenmez Tigen E, Tandogdu Z, Ergonul O, Altinkanat G, Gunaydin B, Ozgen M, Sariguzel N, Erturk Sengel B, Odabasi Z, Cek M, Tokuc R, Turkeri L, Mulazimoglu L, Korten V (2014) Outcomes of fecal carriage of extended-spectrum β-lactamase after transrectal ultrasound-guided biopsy of the prostate. Urology 84(5):1008–1015. https://doi.org/10.1016/j.urology.2014.04.060

    Article  PubMed  Google Scholar 

  30. Tops SCM, Kolwijck E, Koldewijn EL, Somford DM, Delaere FJM, van Leeuwen MA, Breeuwsma AJ, de Vocht TF, Broos HJHP, Schipper RA, Steffens MG, Teerenstra S, Wegdam-Blans MCA, de Brauwer E, van den Bijllaardt W, Leenders ACAP, Sedelaar JPM, Wertheim HFL (2023) Rectal culture-based versus empirical antibiotic prophylaxis to prevent infectious complications in men undergoing transrectal prostate biopsy: a randomized. Nonblinded Multicent Trial Clin Infect Dis 76(7):1188–1196. https://doi.org/10.1093/cid/ciac913

    Article  Google Scholar 

  31. Minamida S, Satoh T, Tabata K, Kimura M, Tsumura H, Kurosaka S, Matsumoto K, Fujita T, Iwamura M, Baba S (2011) Prevalence of fluoroquinolone-resistant Escherichia coli before and incidence of acute bacterial prostatitis after prostate biopsy. Urology 78(6):1235–1239. https://doi.org/10.1016/j.urology.2011.07.1392

    Article  PubMed  Google Scholar 

  32. Steensels D, Slabbaert K, De Wever L, Vermeersch P, Van Poppel H, Verhaegen J (2012) Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy–should we reassess our practices for antibiotic prophylaxis. Clin Microbiol Infect 18(6):575–581. https://doi.org/10.1111/j.1469-0691.2011.03638.x

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. A. Bouzouita and A. Rehaiem have contributed equally to this work.

Authors and Affiliations

  1. Urology Department, Charles Nicolle Hospital, Tunis, Tunisia

    A. Bouzouita, A. Saadi, S. Zaghbib, M. Chakroun, H. Ayed, A. Derouiche & M. R. Ben Slama

  2. Microbiology Departments, Charles Nicolle Hospital, Tunis, Tunisia

    A. Rehaiem, A. Ferjani & I. Boutiba-Ben Boubaker

  3. Faculty of Medicine of Tunis, LR99ES09 Research Laboratory (Antimicrobial Resistance), University of Tunis El Manar, 1007, Tunis, Tunisia

    A. Rehaiem, A. Ferjani & I. Boutiba-Ben Boubaker

Authors
  1. A. Bouzouita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Rehaiem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Saadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Zaghbib
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Chakroun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Ayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Ferjani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Derouiche
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. I. Boutiba-Ben Boubaker
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. R. Ben Slama
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A. B conceptualization of the protocol, choice of methods, rectal swab supervising, results interpretations, check and manuscript draft, and revising; A. R design of microbiological analysis, strains isolation and identification, antibiotic susceptibility testing, data analysis, interpretations, and check and revising of manuscript; A. S rectal swab monitoring, resources validation, data analysis, and writing of the original draft of manuscript; S. Z, M. C, H. A, A.D: collect rectal swabs, patient follow-up, and statistical analysis. F. A revised the draft paper critically for important intellectual content; Pr. I. B-BB and Pr. MR BS supervisor and main reviewer and editor of the final version of the manuscript. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to A. Rehaiem.

Ethics declarations

Conflict of interest

Authors have no conflicts of interest.

Ethical approval

Ethical approval for this study protocol, the patient information sheet, and the informed consent form were approved by the local Ethics Committee of the Charles Nicolle Hospital: CHN Ethics Committee member of the Office for the Protection of Human Research (OHRP) in the United States recognized under the number FWA:FWA00032748/IID:IORG0011243.

Research involving human participants and/or animals

The study involves Humans Participants and has been carried out in accordance with the ethical standards.

Informed consent

All patients undergoing TRUS-BP were included following informed consent.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bouzouita, A., Rehaiem, A., Saadi, A. et al. Antimicrobial prophylaxis protocol based on rectal swab culture before prostate biopsy to prevent infectious complications: a prospective randomized comparative study. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-03998-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11255-024-03998-7

Keywords

Search

Navigation