Third-Generation Cephalosporin Prophylaxis More Effective for Transrectal Prostatic Biopsy

SAN FRANCISCO—In areas where Escherichia coli resistance to the fluoroquinolones exceeds 20%, a prophylactic regimen containing a third-generation cephalosporin is more effective than a fluoroquinolone in patients undergoing transrectal ultrasono-guided prostatic biopsy (TRUS-PBx), reported Nak-Hyun Kim, MD, from the department of medicine at Seoul National University College of Medicine, Seoul, South Korea, at IDWeek 2013.

Read More of MPR's Exclusive Coverage of IDWeek 2013

Prior to September 2012, the prophylactic antibiotic regimen for TRUS-PBx at his institution was ciprofloxacin 500mg twice daily for 5 days starting one day before biopsy. This was then changed to ceftriaxone 1g IV 1 hour before biopsy plus cefixime 100mg twice daily for 5 days starting on the day before biopsy.

Dr. Kim and study researchers retrospectively reviewed electronic medical records of patients who underwent TRUS-PBx 14 months before and 7 months after the change in protocol for infectious complications. Emergency room visits and admissions within 30 days following biopsy, rates of infectious and noninfectious complications, and microbiology of TRUS-PBx–related infections using culture results and antimicrobial susceptibilities were compared.

TRUS-PBx–related infection rates were 3.68% (30/816) before the new protocol and 1.54% (6/389) after the new protocol (P=0.027). E. coli was the predominant organism both before (80%, or 24 of 30 patients) and after (66.7%, 4 of 6 patients) the new protocol was implemented.

Ciprofloxacin resistance was 100% (24 of 24 patients) before and 75% (3 of 4 patients) after the protocol was instituted. Also, ESBLs were detected in 37.5% (9/24) of patients before the new protocol and 75% (3/4) after the protocol change.