Deepak Batura1, G Gopal Rao1, Peder Bo Nielsen1, André Charlett1. 1. Departments of Urology and *Microbiology, Northwick Park Hospital, London, and †Statistics, Modelling and Bioinformatics Department, Centre of Infections, Health Protection Agency, UK.
Abstract
OBJECTIVE: • To examine the efficacy of adding amikacin to fluoroquinolone-based antimicrobial prophylaxis in preventing transrectal ultrasonography-guided prostate biopsy (TGB) associated infections. PATIENTS AND METHODS: • Infections after TGB were compared before adding amikacin to antimicrobial prophylaxis (2006) with those that occurred after adding amikacin to the prophylaxis (2007 and 2008). • During both periods antimicrobial prophylaxis consisted of ciprofloxacin, co-amoxiclav and metronidazole except after August 2008 when co-amoxiclav was discontinued. • Amikacin was added to the prophylaxis protocol in the period 2007 and 2008. RESULTS: • Before adding amikacin 11 of 281 (3.9%) patients developed infections after TGB (seven urinary tract infections (UTIs) and seven bacteraemias) whereas after adding amikacin six UTIs and two bacteraemias occurred in 590 (1.4%) patients. • In both periods, most of the strains causing the infections were ciprofloxacin resistant (2006: 13 of 14; 2007 and 2008: seven of eight). • Overall, there is strong statistical evidence that the total infection rate was significantly reduced after the inclusion of amikacin into the prostate biopsy prophylaxis regimen. • In 2007 and 2008 when amikacin was included in prophylaxis, the bacteraemia rate was reduced to just over one-tenth of the rate in 2006 before introducing amikacin (P= 0.002). • Although just failing to reach the conventional significance level of 0.05, the evidence suggests a reduction in UTI by an estimated 60% after adding amikacin. CONCLUSION: • We conclude that adding amikacin to fluoroquinolone-based antimicrobial prophylaxis in areas with high fluoroquinolone resistance confers significant benefit in preventing infections after TGB.
OBJECTIVE: • To examine the efficacy of adding amikacin to fluoroquinolone-based antimicrobial prophylaxis in preventing transrectal ultrasonography-guided prostate biopsy (TGB) associated infections. PATIENTS AND METHODS: • Infections after TGB were compared before adding amikacin to antimicrobial prophylaxis (2006) with those that occurred after adding amikacin to the prophylaxis (2007 and 2008). • During both periods antimicrobial prophylaxis consisted of ciprofloxacin, co-amoxiclav and metronidazole except after August 2008 when co-amoxiclav was discontinued. • Amikacin was added to the prophylaxis protocol in the period 2007 and 2008. RESULTS: • Before adding amikacin 11 of 281 (3.9%) patients developed infections after TGB (seven urinary tract infections (UTIs) and seven bacteraemias) whereas after adding amikacin six UTIs and two bacteraemias occurred in 590 (1.4%) patients. • In both periods, most of the strains causing the infections were ciprofloxacin resistant (2006: 13 of 14; 2007 and 2008: seven of eight). • Overall, there is strong statistical evidence that the total infection rate was significantly reduced after the inclusion of amikacin into the prostate biopsy prophylaxis regimen. • In 2007 and 2008 when amikacin was included in prophylaxis, the bacteraemia rate was reduced to just over one-tenth of the rate in 2006 before introducing amikacin (P= 0.002). • Although just failing to reach the conventional significance level of 0.05, the evidence suggests a reduction in UTI by an estimated 60% after adding amikacin. CONCLUSION: • We conclude that adding amikacin to fluoroquinolone-based antimicrobial prophylaxis in areas with high fluoroquinolone resistance confers significant benefit in preventing infections after TGB.
Authors: Hosam M Zowawi; Patrick N A Harris; Matthew J Roberts; Paul A Tambyah; Mark A Schembri; M Diletta Pezzani; Deborah A Williamson; David L Paterson Journal: Nat Rev Urol Date: 2015-09-01 Impact factor: 14.432
Authors: N Singla; J Walker; S L Woldu; N M Passoni; K de la Fuente; C G Roehrborn Journal: Prostate Cancer Prostatic Dis Date: 2017-01-24 Impact factor: 5.554