Lu Yang1, Zhuang Tang1, Liang Gao1, Tao Li1, Yongji Chen1, Liangren Liu1, Ping Han1, Xiang Li1, Qiang Dong2, Qiang Wei3. 1. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. 2. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. dongqiang1970@qq.com. 3. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. weiqiang163163@163.com.
Abstract
BACKGROUND: Although frequent use of prophylactic antibiotics for patients undergoing transrectal prostate biopsy (TRPB), incidences of urinary tract infection (UTI) and bacterial resistance are still increasing. We evaluated the efficacy of augmented prophylactic antibiotics in patients undergoing TRPB. METHODS: A systematic search of Embase(®), PubMed(®), and the Cochrane Library was executed to identify all eligible studies that compared the effects of augmented antibiotic prophylaxis (combined drugs) with single antibiotic prophylaxis on behalf of patients undergoing TRPB. Outcomes qualified in this review included bacteriuria, bacteremia, drug-resistant bacteria on urine culture, drug-resistant bacteria on blood culture, fever, UTI, sepsis, and hospitalization. RESULTS: A total of eight publications were identified and included in the review, including three randomized controlled trials with 659 patients and five case-control studies involving 3404 patients. All outcomes, including bacteriuria [relative risk (RR) 4.25, 95 % confidence interval (CI) 1.96-9.22, P = 0.0003], bacteremia (RR 4.96, 95 % CI 2.31-10.67, P < 0.0001), drug-resistant bacteriuria (RR 3.52, 95 % CI 1.41-8.78, P = 0.007), drug-resistant bacteremia (RR 4.94, 95 % CI 2.17-11.24, P = 0.0001), fever (RR 2.75, 95 % CI 1.63-4.62, P = 0.0001), UTI (RR 3.76, 95 % CI 2.57-5.48, P < 0.00001), and hospitalization (RR 3.90, 95 % CI 2.64-5.75, P < 0.00001) significantly favored the augmented antibiotic use. CONCLUSIONS: One additional type of antibiotic (usually one single dose) added to the basic antibiotic prophylaxis modality, defined as augmented prophylaxis, could contribute to the reduction in severe infection and drug resistance, particularly in high-risk patients.
BACKGROUND: Although frequent use of prophylactic antibiotics for patients undergoing transrectal prostate biopsy (TRPB), incidences of urinary tract infection (UTI) and bacterial resistance are still increasing. We evaluated the efficacy of augmented prophylactic antibiotics in patients undergoing TRPB. METHODS: A systematic search of Embase(®), PubMed(®), and the Cochrane Library was executed to identify all eligible studies that compared the effects of augmented antibiotic prophylaxis (combined drugs) with single antibiotic prophylaxis on behalf of patients undergoing TRPB. Outcomes qualified in this review included bacteriuria, bacteremia, drug-resistant bacteria on urine culture, drug-resistant bacteria on blood culture, fever, UTI, sepsis, and hospitalization. RESULTS: A total of eight publications were identified and included in the review, including three randomized controlled trials with 659 patients and five case-control studies involving 3404 patients. All outcomes, including bacteriuria [relative risk (RR) 4.25, 95 % confidence interval (CI) 1.96-9.22, P = 0.0003], bacteremia (RR 4.96, 95 % CI 2.31-10.67, P < 0.0001), drug-resistant bacteriuria (RR 3.52, 95 % CI 1.41-8.78, P = 0.007), drug-resistant bacteremia (RR 4.94, 95 % CI 2.17-11.24, P = 0.0001), fever (RR 2.75, 95 % CI 1.63-4.62, P = 0.0001), UTI (RR 3.76, 95 % CI 2.57-5.48, P < 0.00001), and hospitalization (RR 3.90, 95 % CI 2.64-5.75, P < 0.00001) significantly favored the augmented antibiotic use. CONCLUSIONS: One additional type of antibiotic (usually one single dose) added to the basic antibiotic prophylaxis modality, defined as augmented prophylaxis, could contribute to the reduction in severe infection and drug resistance, particularly in high-risk patients.
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