Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

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.

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

Similar content being viewed by others

References

  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.

    Article  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Puig J, Darnell A, Bermúdez P et al (2006) Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary? Eur Radiol 16(4):939–943

    Article  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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):461–466

    Article  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  9. Carey JM, Korman HJ (2001) Transrectal ultrasound guided biopsy of the prostate. Do enemas decrease clinically significant complications? J Urol 166(1):82–85

    Article  CAS  Google Scholar 

  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):1021–1023

    Article  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  Google Scholar 

  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):2216–2219

    PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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):1877–1881

    Article  CAS  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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):2046–2051

    Article  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  24. Lindert KA, Kabalin JN, Terris MK (2000) Bacteremia and bacteriuria after transrectal ultrasound guided prostate biopsy. J Urol 164(1):76–80

    Article  CAS  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Comprehensive Urogenital Cancer Center, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, 59, Liuting Street, Ningbo, Zhejiang, 315010, China

    Rui Su, Ze-jun Yan, Jun-hui Jiang & Qi Ma

  2. School of medicine, Ningbo University, 818 Fenghua Road, Ningbo, Zhejiang, 315000, China

    Kai-yun Wang & Dong Zhang

  3. Translational Research Laboratory for Urology, the Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, 59, Liuting Street, Ningbo, Zhejiang, 315010, China

    Qi Ma

Authors
  1. Rui Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kai-yun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ze-jun Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun-hui Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qi Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qi Ma.

Ethics declarations

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.

Additional information

Publisher’s note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Su, R., Wang, Ky., Zhang, D. et al. Comparison of levofloxacin-based prophylaxis regimens for transrectal prostate biopsy: a prospective randomized single-center study. Eur J Clin Microbiol Infect Dis 38, 967–971 (2019). https://doi.org/10.1007/s10096-019-03541-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-019-03541-y

Keywords

Search

Navigation