Susan Scott1,2, Patrick N Harris1,3,4, Deborah A Williamson5, Michael A Liss6, Suhail A R Doi7, Matthew J Roberts8,9. 1. Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. 2. Department of Urology, Sunshine Coast University Hospital, Birtinya, QLD, Australia. 3. The University of Queensland, Centre for Clinical Research, Brisbane, QLD, Australia. 4. Central Laboratory, Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. 5. Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia. 6. Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. 7. Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar. 8. Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. m.roberts2@uq.edu.au. 9. The University of Queensland, Centre for Clinical Research, Brisbane, QLD, Australia. m.roberts2@uq.edu.au.
Abstract
PURPOSE: Rectal culture screening for fluoroquinolone (FQ)-resistant Enterobacteriaceae before transrectal ultrasound guided prostate (TRUSPB) biopsy and targeted antibiotic prophylaxis (TAP) may decrease post-TRUSPB infection rates compared to empiric (EAP) regimens. The objective of this study was to evaluate the effectiveness of targeted relative to empiric prophylaxis regimens on rates of infectious complications after TRUSPB and to determine the baseline prevalence of FQ resistance based on prior rectal swabs. METHODS: An electronic search within literature databases including EMBASE and Web of Science (all databases) for articles assessing TAP as an approach to TRUSPB prophylaxis was conducted. Quality assessment was performed using the Hoy instrument. Meta-analysis was performed using MetaXL 5.3. RESULTS: From 15 studies (eight retrospective and seven prospective) representing 12,320 participants, infectious complication incidence was 3.4% in EAP and 0.8% in TAP patients. The number needed to treat with TAP to avoid one more infection when compared to the EAP group was 39. Effect sizes were homogeneous. Prevalence of FQ resistance showed low (15%) and high (28%) subgroups, likely due to region of origin (within and outside USA, respectively). CONCLUSIONS: Rectal culture prior to TRUSPB and use of TAP adjusts for endemic FQ resistance and is associated with less infectious complications and resulting morbidity when compared to EAP. Overtreatment associated with augmented prophylaxis approaches may be reduced as a result. Further prospective assessment and cost-benefit analyses are required before widespread implementation can be recommended.
PURPOSE: Rectal culture screening for fluoroquinolone (FQ)-resistant Enterobacteriaceae before transrectal ultrasound guided prostate (TRUSPB) biopsy and targeted antibiotic prophylaxis (TAP) may decrease post-TRUSPB infection rates compared to empiric (EAP) regimens. The objective of this study was to evaluate the effectiveness of targeted relative to empiric prophylaxis regimens on rates of infectious complications after TRUSPB and to determine the baseline prevalence of FQ resistance based on prior rectal swabs. METHODS: An electronic search within literature databases including EMBASE and Web of Science (all databases) for articles assessing TAP as an approach to TRUSPB prophylaxis was conducted. Quality assessment was performed using the Hoy instrument. Meta-analysis was performed using MetaXL 5.3. RESULTS: From 15 studies (eight retrospective and seven prospective) representing 12,320 participants, infectious complication incidence was 3.4% in EAP and 0.8% in TAP patients. The number needed to treat with TAP to avoid one more infection when compared to the EAP group was 39. Effect sizes were homogeneous. Prevalence of FQ resistance showed low (15%) and high (28%) subgroups, likely due to region of origin (within and outside USA, respectively). CONCLUSIONS: Rectal culture prior to TRUSPB and use of TAP adjusts for endemic FQ resistance and is associated with less infectious complications and resulting morbidity when compared to EAP. Overtreatment associated with augmented prophylaxis approaches may be reduced as a result. Further prospective assessment and cost-benefit analyses are required before widespread implementation can be recommended.
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: Jeremy P Grummet; Mahesha Weerakoon; Sean Huang; Nathan Lawrentschuk; Mark Frydenberg; Daniel A Moon; Mary O'Reilly; Declan Murphy Journal: BJU Int Date: 2014-02-19 Impact factor: 5.588
Authors: Michael A Liss; Behfar Ehdaie; Stacy Loeb; Maxwell V Meng; Jay D Raman; Vanessa Spears; Sean P Stroup Journal: J Urol Date: 2017-03-29 Impact factor: 7.450
Authors: Matthew J Roberts; Susan Scott; Patrick N Harris; Kurt Naber; Florian M E Wagenlehner; Suhail A R Doi Journal: World J Urol Date: 2017-12-29 Impact factor: 4.226
Authors: Michael A Liss; James R Johnson; Stephen B Porter; Brian Johnston; Connie Clabots; Kyle Gillis; Unwanaobong Nseyo; Marc Holden; Kyoko Sakamoto; Joshua Fierer Journal: Clin Infect Dis Date: 2014-12-16 Impact factor: 9.079
Authors: Suhail A R Doi; Jan J Barendregt; Shahjahan Khan; Lukman Thalib; Gail M Williams Journal: Contemp Clin Trials Date: 2015-05-21 Impact factor: 2.226
Authors: Matthew J Roberts; Alastair Macdonald; Sachinka Ranasinghe; Harrison Bennett; Patrick E Teloken; Patrick Harris; David Paterson; Geoff Coughlin; Nigel Dunglison; Rachel Esler; Robert A Gardiner; Thomas Elliott; Louisa Gordon; John Yaxley Journal: Prostate Cancer Prostatic Dis Date: 2020-08-05 Impact factor: 5.554
Authors: Sofie C M Tops; Evert L Koldewijn; Diederik M Somford; Anita M P Huis; Eva Kolwijck; Heiman F L Wertheim; Marlies E J L Hulscher; J P Michiel Sedelaar Journal: BMC Urol Date: 2020-03-12 Impact factor: 2.264
Authors: Sofie C M Tops; Anita M P Huis; Willeke Trompers; Anke J M Oerlemans; J P Michiel Sedelaar; Eva Kolwijck; Heiman F L Wertheim; Marlies E J L Hulscher Journal: JAC Antimicrob Resist Date: 2021-11-17