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Infective complications after transrectal ultrasound‐guided prostate biopsy following a new protocol for antibiotic prophylaxis aimed at reducing hospital‐acquired infections
Author(s) -
Madden Thomas,
Doble Andrew,
Aliyu Sani H.,
Neal David E.
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2011.10160.x
Subject(s) - medicine , antibiotic prophylaxis , antibiotics , ciprofloxacin , complication , regimen , gentamicin , surgery , prostate biopsy , prostate , cancer , biology , microbiology and biotechnology
Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add?• Clostridium Difficile infections have been a serious problem throughout the NHS and have forced clinicians to change the types of antibiotics they routinely prescribe. • Ciprofloxacin is a good choice of prophylactic agent for TRUSP Bx. • Co‐amoxiclav and gentamicin have never been studied in combinations as prophylaxis for TRUSP Bx.• Co‐amoxiclav and gentamicin in combination are an inferior choice of prophylactic agent compared to Ciprofloxacin. • Development of Clostridium Difficile infection does not appear to be a concern when using Ciprofloxacin as prophylaxis for TRUSP Bx. • Any change in antibiotic usage should take into account local knowledge of antiobiotic resitance as well as published evidence.OBJECTIVE • To compare the infective complications between two different antibiotic regimens used as prophylaxis for transrectal ultrasound‐guided prostate biopsy (TRUSP Bx). PATIENTS AND METHODS • The records of 709 consecutive patients undergoing TRUSP Bx over a period of 20 months at a UK teaching hospital were examined retrospectively. • All clinic letters, microbiology reports and admission records were examined for each patient. RESULTS • Within the study period a total of 454 patients received prophylaxis with ciprofloxacin; 11 of these patients (2.4%) developed an infective complication within 4 weeks of the TRUSP Bx. • A total of 255 patients received prophylaxis with co‐amoxiclav and gentamicin; 33 patients (12.9%) in this group had an infective complication. • No cases of Clostridium difficile infection were recorded for any of these patients within 1 month of receiving antibiotics. • Re‐introduction of the original regimen led to a fall in infective complications. CONCLUSION • Understandable concerns about the development of hospital‐acquired infection led to a new protocol for antibiotic prophylaxis which in turn led to a number of patients being put at increased risk of potentially serious infective complications. Antibiotic prophylaxis must reflect tissue penetration, the organisms encountered and their susceptibilities, as well as being based on objective evidence.