Advertisement

Comparison of levofloxacin-based prophylaxis regimens for transrectal prostate biopsy: a prospective randomized single-center study

  • Rui Su
  • Kai-yun Wang
  • Dong Zhang
  • Ze-jun Yan
  • Jun-hui Jiang
  • Qi MaEmail author
Original Article
  • 26 Downloads

Abstract

To develop an optimal prophylactic regimen among Chinese patients who accept transrectal prostate biopsy. We enrolled 420 patients who accepted transrectal prostate biopsy. They were randomly classified into three groups (n = 140 for each): Group A received a single 500-mg tablet of levofloxacin without enema; group B received a single 500-mg tablet of levofloxacin plus enema; group C received 3-day levofloxacin orally plus enema. Patients were assessed if they had a febrile urinary tract infection (FUTI). The incidence of FUTI was compared among groups. Subgroup analysis was performed between patients at high and low risk of infection in each group. There were 15 cases developed FUTI: 7 (5%), 6 (4.3%), and 2 (1.4%), respectively, in groups A, B, and C. Of the 15 patients who developed FUTI, Escherichia coli was detected in blood culture in two cases. Urine culture results were all negative. FUTI patients (73.3% (11/15)) had at least one high risk factor. Subgroup analysis showed that the incidence of FUTI in group A was significantly higher than that in group C among high-risk patients. There was no statistical difference between group A and group B among both high- and low-risk patients. A single 500-mg dose of levofloxacin without enema represents excellent prophylaxis for transrectal prostate biopsy in Chinese patients at low risk of infection. For those at high risk, 3-day levofloxacin prophylaxis is the optimal regimen. Prebiopsy enema provides no clinically significant outcome advantage and is unnecessary.

Keywords

Fluoroquinolone Prophylaxis Enema Prostate biopsy 

Notes

Funding

This work was supported in part by Grant 2018A610297 from Ningbo Natural Science Fund and Grants LY18H050003 and LY17H050001 from the Zhejiang Natural Science Fund.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained from the Ningbo First Hospital Research Ethics Committee.

Informed consent

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

References

  1. 1.
    Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90.  https://doi.org/10.3322/caac.20107. Google Scholar
  2. 2.
    Ongün S, Aslan G, Avkan-Oguz V (2012) The effectiveness of single-dose fosfomycin as antimicrobial prophylaxis for patients undergoing transrectal ultrasound-guided biopsy of the prostate. Urol Int 89(4):439–444.  https://doi.org/10.1159/000342370 Google Scholar
  3. 3.
    Lu DD, Raman JD (2016) Strategies for prevention of ultrasound-guided prostate biopsy infections. Infect Drug Resist. 9:161–169.  https://doi.org/10.2147/IDR.S96163. Google Scholar
  4. 4.
    Puig J, Darnell A, Bermúdez P et al (2006) Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary? Eur Radiol 16(4):939–943Google Scholar
  5. 5.
    Walker JT, Singla N, Roehrborn CG (2016) Reducing infectious complications following transrectal ultrasound-guided prostate biopsy: a systematic review. Rev Urol 18(2):73–89.  https://doi.org/10.3909/riu0713 Google Scholar
  6. 6.
    Wu YP, Li XD, Ke ZB et al (2018) Risk factors for infectious complications following transrectal ultrasound-guided prostate biopsy. Infect Drug Resist 11:1491–1497.  https://doi.org/10.2147/IDR.S171162. Google Scholar
  7. 7.
    Jeon SS, Woo SH, Hyun JH et al (2003) Bisacodyl rectal preparation can decrease infectious complications of transrectal ultrasound-guided prostate biopsy. Urology. 62(3):461–466Google Scholar
  8. 8.
    Yildirim ME, Badem H, Cavis M et al (2015) The comparison of the influence between two different bowel preparation methods on sepsis after prostate biopsies. Cent European J Urol 68(1):91–94.  https://doi.org/10.5173/ceju.2015.01.424 Google Scholar
  9. 9.
    Carey JM, Korman HJ (2001) Transrectal ultrasound guided biopsy of the prostate. Do enemas decrease clinically significant complications? J Urol 166(1):82–85Google Scholar
  10. 10.
    Griffith BC, Morey AF, Ali-Khan MM et al (2002) Single dose levofloxacin prophylaxis for prostate biopsy in patients at low risk. J Urol 168(3):1021–1023Google Scholar
  11. 11.
    Zaytoun OM, Anil T, Moussa AS et al (2011) Morbidity of prostate biopsy after simplified versus complex preparation protocols: assessment of risk factors. Urology. 77(4):910–914.  https://doi.org/10.1016/j.urology.2010.12.033 Google Scholar
  12. 12.
    Zani EL, Clark OA, Rodrigues Netto N Jr (2011) Antibiotic prophylaxis for transrectal prostate biopsy. Cochrane Database Syst Rev 5:CD006576.  https://doi.org/10.1002/14651858 Google Scholar
  13. 13.
    Sabbagh R, McCormack M, Péloquin F et al (2004) A prospective randomized trial of 1-day versus 3-day antibiotic prophylaxis for transrectal ultrasound guided prostate biopsy. Can J Urol 11(2):2216–2219Google Scholar
  14. 14.
    Linden-Castro E, Pelayo-Nieto M, Alias-Melgar A et al (2014) Single dose of levofloxacin versus three dosages for prophylaxis in prostate biopsy. Int Sch Res Notices 2014:875670.  https://doi.org/10.1155/2014/875670 Google Scholar
  15. 15.
    Qiao LD, Chen S, Wang XF et al (2016) A multi-center, controlled, randomized, open-label clinical study of levofloxacin for preventing infection during the perioperative period of ultrasound-guided transrectal prostate biopsy. Eur J Clin Microbiol Infect Dis 35(11):1877–1881Google Scholar
  16. 16.
    Chiang BJ, Pu YS, Chung SD (2013) Quinolone prophylaxis in transrectal ultrasound guided prostate biopsy: an eight-year single center experience. Scientific World Journal. 2013:452107.  https://doi.org/10.1155/2013/452107 Google Scholar
  17. 17.
    Unnikrishnan R, EI-Shafei A, Klein EA et al (2015) For single dosing, levofloxacin is superior to ciprofloxacin when combined with an aminoglycoside in preventing severe infections after prostate biopsy. Urology 85(6):1241–1246.  https://doi.org/10.1016/j.urology. Google Scholar
  18. 18.
    Seo YE, Ryu H, Oh JJ et al (2018) Clinical importance of antibiotic regimen in transrectal ultrasound-guided prostate biopsy: a single Center analysis of nine thousand four hundred eighty-seven cases. Surg Infect 19(7):704–710.  https://doi.org/10.1089/sur.2018.094 Google Scholar
  19. 19.
    Togo Y, Kubo T, Taoka R et al (2014) Occurrence of infection following prostate biopsy procedures in Japan: Japanese Research Group for Urinary Tract Infection (JRGU)—a multi-center retrospective study. J Infect Chemother 20(4):232–237.  https://doi.org/10.1016/j.jiac.2013.10.003. Google Scholar
  20. 20.
    Drusano GL, Preston SL, Van Guilder M et al (2000) A population pharmacokinetic analysis of the penetration of the prostate by levofloxacin. Antimicrob Agents Chemother 44(8):2046–2051Google Scholar
  21. 21.
    Adibi M, Hornberger B, Bhat D et al (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 Google Scholar
  22. 22.
    Wagenlehner FM, van Oostrum E, Tenke P et al (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(3):521–527.  https://doi.org/10.1016/j.eururo.2012.06.003. Google Scholar
  23. 23.
    Ivan SJ, Sindhwani P (2018) Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions. Int Urol Nephrol 50(11):1923–1937.  https://doi.org/10.1007/s11255-018-1971-1 Google Scholar
  24. 24.
    Lindert KA, Kabalin JN, Terris MK (2000) Bacteremia and bacteriuria after transrectal ultrasound guided prostate biopsy. J Urol 164(1):76–80Google Scholar
  25. 25.
    Tsai YS, Chen CH, Jou YC et al (2014) Febrile infection in post-prostate biopsy: results of a ten-year single-institution study in South Taiwan. Surg Infect 15(1):24–28.  https://doi.org/10.1089/sur.2012.216 Google Scholar
  26. 26.
    Simsir A, Kismali E, Mammadov R et al (2010) Is it possible to predict sepsis, the most serious complication in prostate biopsy? Urol Int 84(4):395–399.  https://doi.org/10.1159/000296290 Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Rui Su
    • 1
  • Kai-yun Wang
    • 2
  • Dong Zhang
    • 2
  • Ze-jun Yan
    • 1
  • Jun-hui Jiang
    • 1
  • Qi Ma
    • 1
    • 3
    Email author
  1. 1.Comprehensive Urogenital Cancer Center, Ningbo First HospitalThe Affiliated Hospital of Ningbo UniversityZhejiangChina
  2. 2.School of medicineNingbo UniversityZhejiangChina
  3. 3.Translational Research Laboratory for Urology, the Key Laboratory of Ningbo City, Ningbo First HospitalThe Affiliated Hospital of Ningbo UniversityZhejiangChina

Personalised recommendations