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Infektionskomplikationen bei Prostatabiopsie 2020 – Was hat sich geändert?

Infectious complications following prostate biopsy—Major changes 2020

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Zusammenfassung

Hintergrund

Infektionskomplikationen nach Prostatabiopsie sind von zunehmender Relevanz und Fluorchinolone sind als perioperative Antibiotikaprophylaxe in Deutschland durch das Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) nicht mehr zugelassen.

Ziel der Arbeit

Diese Übersichtsarbeit soll aufzeigen, wie Infektionskomplikationen bei der Prostatabiopsie reduziert werden können.

Material und Methoden

Die Leitliniengruppe Urologische Infektionen der Europäischen Gesellschaft für Urologie (EAU) hat kürzlich eine Metaanalyse in zwei Teilen auf der Basis randomisiert kontrollierter Studien (RCTs) veröffentlicht, deren wichtigste Inhalte hier dargestellt werden sollen.

Ergebnisse

Die transperineale Prostatabiopsie ist mit signifikant weniger Infektionskomplikationen assoziiert als die transrektale Biopsie. Sollte dennoch die transrektale Biopsie gewählt werden, sind eine intrarektale Reinigung mit Povidon-Jod sowie eine antibiotische Prophylaxe ohne Fluorchinolone zu verwenden. Als antibiotische Prophylaxestrategien kommen die zielgerichtete Prophylaxe nach Empfindlichkeitstestung der Enddarmflora, die augmentierte Prophylaxe mit mehreren Antibiotika und die empirische Monoprophylaxe mit Nicht-Fluorchinolonen in Frage. Daten aus RCTs liegen hier für Aminoglykoside, 3. Generationscephalosporine und Fosfomycin trometamol vor.

Diskussion

Die transperineale Biopsie ist aufgrund signifikant niedrigerer Infektionen bevorzugt zu verwenden. Sollte die transrektale Biopsie weiterhin zum Einsatz kommen ist zu beachten, dass Fluorchinolone als Infektionsprophylaxe nicht mehr zugelassen sind.

Abstract

Background

Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been suspended in Germany by the national authorities.

Objectives

This review is intended to highlight current strategies for reducing infectious complications following prostate biopsy.

Materials and methods

The European Association of Urology (EAU) guideline group on urological infections recently published a meta-analysis in two parts based on randomized controlled trials (RCTs). The most important contents shall be presented here.

Results

Transperineal prostate biopsy is associated with significantly reduced infectious complications than transrectal biopsy. If transrectal biopsy is performed, intrarectal cleaning with povidone-iodine and antibiotic prophylaxis without fluoroquinolones should be chosen. Antibiotic prophylactic strategies include targeted prophylaxis after susceptibility testing of the rectal flora, augmented prophylaxis with multiple antibiotics and empiric monoprophylaxis with nonfluoroquinolones. Here data from RCTs are available for aminoglycosides, third generation cephalosporines, and fosfomycin trometamol.

Conclusions

The transperineal approach is preferred to reduce prostate biopsy-related infections. Fluoroquinolones are no longer approved for prophylaxis. Thus, alternative antibiotics based on local resistance, or targeted prophylaxis, in conjunction with povidone-iodine rectal preparation are recommended for transrectal prostate biopsy.

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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 & F. Wagenlehner

  2. alta uro AG, Basel, Schweiz

    G. Bonkat

Authors
  1. A. Pilatz
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  2. G. Bonkat
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  3. F. Wagenlehner
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Correspondence to A. Pilatz.

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Interessenkonflikt

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

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

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Pilatz, A., Bonkat, G. & Wagenlehner, F. Infektionskomplikationen bei Prostatabiopsie 2020 – Was hat sich geändert?. Urologe 59, 1486–1491 (2020). https://doi.org/10.1007/s00120-020-01365-9

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