Elshal AM, et al. - Authors compared the effectiveness of 3 chemoprophylaxis approaches in the prevention of post-transrectal biopsy infectious complications (TBICs). Single-dose gentamicin when used to augment prophylaxis was considered to be an effective and practical approach. For cases with contraindication to gentamicin, targeted prophylaxis could be reserved.

Methods

• Experts randomly assigned patients to receive ciprofloxacin 3 days 500 mg B.I.D 3 days starting the night prior to biopsy (standard prophylaxis), augmented prophylaxis using ciprofloxacin and single preprocedure shot of 160 mg gentamicin IM (augmented prophylaxis) and rectal swab culture-based prophylaxis (targeted prophylaxis).
• They assessed patients 2 weeks prior to biopsy, at biopsy and 2 weeks after.
• Occurrence of post-TBICs that included simple UTI, febrile UTI or sepsis was primary end point.
• Post-biopsy change in the inflammatory markers (TLC, ESR and CRP), unplanned visits, hospitalization and occurrence of fluoroquinolones resistance (FQ-R; bacterial growth on MacConkey agar plate with 10 μg/ml ciprofloxacin) in the fecal carriage of screened men were the secondary end points.

Results

• Findings suggested that between April/2015 and January/2017, standard, augmented and targeted prophylaxes were given to 163, 166 and 167 patients, respectively.
• In 43 (26%), 13 (7.8%) and 34 (20.3%) patients, post-TBICs were reported following standard, augmented and targeted prophylaxes protocols, respectively (P=0.000).
• Results demonstrated that post-TBICs included UTI in 23 (4.6%), febrile UTI in 41 (8.2%) and sepsis in 26 (5.2%) patients.
• In the augmented group, significantly lower number of post-biopsy positive urine culture was depicted (P=0.000).
• Researchers demonstrated that in the 3 groups, the number of biopsy cores was statistically different (P=0.004).
• Data depicted that on multivariate analysis, independently lower post-TBICs (OR 0.2, 95% CI 0.1–0.4,P=0.000) was seen in augmented prophylaxis when compared with the other 2 groups regardless of the number of biopsy cores taken (OR 1.07, 95% CI 0.95–1.17,P=0.229).
• In 4 (2%), 1 (0.6%) and 10 (6%) patients following standard, augmented and targeted prophylaxes, respectively, post-biopsy hospitalization was needed (P=0.014).
• Nonetheless, no statistical differenence was seen in sepsis-related hospitalization.
• In augmented prophylaxis, post-biopsy changes in the inflammatory markers were significantly less (P < 0.05).
• In 139 (83.2%) of the screened men, FQ-R was depicted.