AI Article Synopsis
- An increase in ciprofloxacin-resistant bacteria in patients undergoing transrectal prostate biopsy has led to a need for alternative prophylactic treatments to prevent infections due to standard ciprofloxacin use.
- A study conducted from April 2018 to July 2021 enrolled 1538 patients, who were split into two groups: one receiving standard ciprofloxacin prophylaxis and the other receiving culture-based prophylaxis, with the main goal of comparing infection rates post-biopsy.
- Results indicated that the infection rate was slightly lower in the culture-based group (2.5%) compared to the ciprofloxacin group (4.3%), suggesting that culture-based prophylaxis may be more effective in reducing early infectious complications after the procedure, although other
Article Abstract
Background: An increase in infections after transrectal prostate biopsy (PB), related to an increasing number of patients with ciprofloxacin-resistant rectal flora, necessitates the exploration of alternatives for the traditionally used empirical prophylaxis of ciprofloxacin. We compared infectious complication rates after transrectal PB using empirical ciprofloxacin prophylaxis versus culture-based prophylaxis.
Methods: In this nonblinded, randomized trial, between 4 April 2018 and 30 July 2021, we enrolled 1538 patients from 11 Dutch hospitals undergoing transrectal PB. After rectal swab collection, patients were randomized 1:1 to receive empirical prophylaxis with oral ciprofloxacin (control group [CG]) or culture-based prophylaxis (intervention group [IG]). Primary outcome was any infectious complication within 7 days after biopsy. Secondary outcomes were infectious complications within 30 days, and bacteremia and bacteriuria within 7 and 30 days postbiopsy. For primary outcome analysis, the χ2 test stratified for hospitals was used. Trial registration number: NCT03228108.
Results: Data from 1288 patients (83.7%) were available for analysis (CG, 652; IG, 636). Infection rates within 7 days postbiopsy were 4.3% (n = 28) (CG) and 2.5% (n = 16) (IG) (P value = .08; reduction: -1.8%; 95% confidence interval, -.004 to .040). Ciprofloxacin-resistant bacteria were detected in 15.2% (n = 1288). In the CG, the presence of ciprofloxacin-resistant rectal flora resulted in a 6.2-fold higher risk of early postbiopsy infection.
Conclusions: Our study supports the use of culture-based prophylaxis to reduce infectious complications after transrectal PB. Despite adequate prophylaxis, postbiopsy infections can still occur. Therefore, culture-based prophylaxis must be weighed against other strategies that could reduce postbiopsy infections. Clinical Trials Registration. NCT03228108.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10069853 | PMC |
| http://dx.doi.org/10.1093/cid/ciac913 | DOI Listing |
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