Minimizing infectious complications following transrectal prostate biopsy: a proposal for a risk-adapted antibiotic treatment strategy with Ceftriaxone and Ertapenem as key components

Purpose To investigate the effect of pre-biopsy rectal swab and urine screening combined with a risk-adapted antibiotic treatment strategy on reducing post-biopsy infections (PBIs) following multiparametric magnetic resonance imaging (mpMRI)/ transrectal ultrasound (TRUS) fusion-targeted transrectal...

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Bibliographic Details
Published in:World journal of urology 2024-12, Vol.43 (1), p.4
Main Authors: Ortner, Gernot, Fritz, Veronika, Schachtner, Jörg, Gkolezakis, Vasilios, Herrmann, Thomas R.W., Nagele, Udo, Tokas, Theodoros
Format: Article
Language:English
Subjects:
Aged
Anti-Bacterial Agents - therapeutic use
Antibiotic Prophylaxis - methods
Antibiotics
Biopsy
Carbapenems
Ceftriaxone
Ceftriaxone - therapeutic use
Cefuroxime
Ciprofloxacin
Ertapenem
Ertapenem - therapeutic use
Humans
Image-Guided Biopsy - adverse effects
Image-Guided Biopsy - methods
Magnetic resonance imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Nephrology
Oncology
Postoperative Complications - prevention & control
Prophylaxis
Prostate
Prostate - pathology
Prostatic Neoplasms - pathology
Rectum
Retrospective Studies
Risk Assessment
Risk groups
Urine
Urology
β Lactamase
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Summary:Purpose To investigate the effect of pre-biopsy rectal swab and urine screening combined with a risk-adapted antibiotic treatment strategy on reducing post-biopsy infections (PBIs) following multiparametric magnetic resonance imaging (mpMRI)/ transrectal ultrasound (TRUS) fusion-targeted transrectal prostate biopsy (TRPBx). Methods 1119 Patients undergoing mpMRI-TRUS fusion TRPBx between June 2017 and February 2024 were included. Patients were screened for rectal extended-spectrum beta-lactamase (ESBL)/multi-resistant gram-negative (MRGN) and urinary pathogens. Standard-risk patients (rectal non-ESBL/MRGN-carriers) either received Cefuroxime (2017–2020) or Ceftriaxone (2020–2024) intravenously before biopsy. For high-risk patients (rectal ESBL/MRGN-carriers) intravenous Ertapenem was used. Patients with positive urine cultures received oral targeted prophylaxis. PBIs were the primary outcome of the study. We used uni- and multivariable logistic regression analysis (MLRA) to reveal predictors for the main outcome. Results Rectal ESBL/MRGN prevalence was 5.5%. For standard-risk patients, PBI-rates were 8.1% and 0.24% for Cefuroxime and Ceftriaxone ( p  
ISSN:0724-4983
1433-8726
1433-8726
DOI:10.1007/s00345-024-05357-8