Ces Urol 2021, 25(2):106-111 | DOI: 10.48095/cccu2021020

Antibiotic prophylaxis in multiparametric magnetic resonance imaging-guided transrectal prostate biopsy

Jakub Řezáč¹, Otakar Čapoun¹, Roman Sobotka¹, Lenka Kupidlovská², Lukáš Lambert³, Petr Hanuš³, Iva Macová³, Vladimír Černý³, Tomáš Hanuš¹

¹ Urologická klinika VFN a 1. LF UK v Praze

² Ústav lékařské biochemie a laboratorní diagnostiky VFN, Klinická mikrobiologie a ATB centrum, Praha

³ Radiodiagnostická klinika VFN a 1. LF UK v Praze

Introduction: Antibiotic prophylaxis is, according to international recommendations, an integral part of transrectal prostate biopsy. The most used antibiotics are ciprofloxacin and cotrimoxazole. However, the incidence of resistance to both substances has an upward trend. The aim of our work was to evaluate the microbial profile from a rectal swab and to determine the sensitivity of bacterial strains in patients indicated for multiparametric magnetic resonance imaging-guided prostate biopsy.

Material and methods: In the period from 03/2019 to 05/2020, we examined a total of 192 patients. Prophylactically, cotrimoxazole 960 mg p. o. every 12 hours in a total of three doses starting in the morning on the day of the biopsy was most administered. In case of allergy, we recommended ciprofloxacin 750 mg p. o. in the same regime. We performed a rectal swab just before the procedure. Bacterial strains were cultured on common soils, sensitivity was determined qualitatively by the diffusion disk method. We recorded a maximum of three strains and, in the case of resistance, all evaluated antibiotics. We prospectively monitored the occurrence of a septic reaction, characterized by a general alteration of the condition, a temperature above 38 °C and a painful per rectum finding requiring hospitalization within seven days after the procedure.

Results: A total of 266 bacterial strains were found in a total of 170 (88.5 %) patients. The most frequently cultured strain was Escherichia coli with sensitivity to all antibiotics (45.8 % of all patients). Most often, we described Escherichia coli resistance to potentiated aminopenicillin (22 % of strains). Resistance to cotrimoxazole and ciprofloxacin, respectively, was observed in 19 % and 22 % strains, respectively. Resistance to three or more antibiotics has been described in 27 strains. Septic complication occurred in a total of three (1.6 %) patients, we present those in short case reports.

Conclusion: Our results show a similar incidence of pathogens resistant to both commonly used antibiotics. Despite the relatively high incidence of resistance, the number of clinical complications remains low.

Keywords: Antibiotics, biopsy, prophylaxis, prostate cancer.

Received: March 10, 2021; Revised: April 16, 2021; Accepted: April 22, 2021; Prepublished online: April 23, 2021; Published: June 24, 2021