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Table of Contents
LETTER TO EDITOR
Year : 2015  |  Volume : 7  |  Issue : 2  |  Page : 279-280  

Antibiotics prophylaxis before prostate biopsy in practice: Review of online clinical guidelines


Department of Surgery, Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois, USA

Date of Web Publication11-Mar-2015

Correspondence Address:
Illinois Shaheen R Alanee
Department of Surgery, Division of Urology, Southern Illinois University School of Medicine, 301 N, 8th St., St. John's Pavilion, P.O. Box: 19665, Springfield, Illinois 62794-9665
USA
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DOI: 10.4103/0974-7796.152954

PMID: 25835059

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How to cite this article:
Fiuk JV, Holland BC, Dynda DI, Alanee SR. Antibiotics prophylaxis before prostate biopsy in practice: Review of online clinical guidelines . Urol Ann 2015;7:279-80

How to cite this URL:
Fiuk JV, Holland BC, Dynda DI, Alanee SR. Antibiotics prophylaxis before prostate biopsy in practice: Review of online clinical guidelines . Urol Ann [serial online] 2015 [cited 2021 Sep 26];7:279-80. Available from: https://www.urologyannals.com/text.asp?2015/7/2/279/152954

Sir,

The inaugural American Urologic Association (AUA) Quality Improvement Summit on January 25, 2014 introduced the directive to compile a white paper on the incidence, prevention, and treatment of complications related to prostate needle biopsy. We believe this summit brings to the urologic community's attention the critical fact that published guidelines in antibiotic prophylaxis do not reflect the escalating danger of post prostate needle biopsy infections. The known infectious complication rates range from 0.1% to 7%, depending on the antimicrobial agent used. [1] Even with prophylactic antibiotics, 5% of men will develop asymptomatic bacteriuria and 2-3% will develop symptomatic urinary tract infection. [2] The current AUA best practice policy statement on urologic surgery antimicrobial prophylaxis, last updated in February 2012, recommends fluoroquinolones or 1 st through 3 rd generation cephalosporins as the prophylactic antimicrobial agents of choice preceding prostate needle biopsy. This recommendation does not account for the fact that the overall risk of post-biopsy infections has risen over the past decade. [2],[3],[4] It also does not account for the increasing rate of quinolone resistance, as evidenced by the dramatic 22% of men found to have quinolone-resistant flora on prebiopsy rectal swab. [1] While the origin of this change in microbial sensitivity is likely complex and multifactorial, possibly related to increased, inappropriate, or repeated utilization of antibiotics, the fact remains that our guidelines for prophylaxis need to reflect these factors in order to effectively protect patients receiving prostate needle biopsies.

We conducted an online search of www.pubmed.gov and other medical websites for United States publications in English offering guidelines on antibiotic prophylaxis before prostate biopsy for the purpose of reducing the risk of infectious complications using the key words "surgical, antimicrobial, prophylaxis, guidelines." We identified only 17 publications between 2007 and 2014, and 13 of them were available to review in full text. The first-line prophylaxis regimens included primarily cephalosporins or fluoroquinolones (13/13). Trimethoprim-sulfamethoxazole was included as an appropriate first line antibiotic in one of the studies, another two included combinations of gentamicin, ampicillin, metronidazole and clindamycin as the first line prophylaxis. While their infectious complication rates fell well within the 0.1-7% quoted in the literature, the wide variety of regimens used, and the fact that some even differed from the known guidelines, further proves the need for an updated consensus [Table 1].
Table 1: Online published guidelines for antibiotic prophylaxis before prostate biopsy in the United States

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   References Top

1.
Liss MA, Chang A, Santos R, Nakama-Peeples A, Peterson EM, Osann K, et al. Prevalence and significance of fluoroquinolone resistant Escherichia coli in patients undergoing transrectal ultrasound guided prostate needle biopsy. J Urol 2011;185:1283-8.  Back to cited text no. 1
    
2.
Zani EL, Clark OA, Rodrigues Netto N Jr. Antibiotic prophylaxis for transrectal prostate biopsy. Cochrane Database Syst Rev 2011;5:CD006576.  Back to cited text no. 2
    
3.
Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH, et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 2013;189 1 Suppl: S12-7.  Back to cited text no. 3
    
4.
Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: Data from SEER-Medicare. J Urol 2011;186:1830-4.  Back to cited text no. 4
    



 
 
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