Abstract
Purpose
To evaluate the benefit of targeted antibiotic prophylaxis (TAP) based on rectal swab culture in comparison with standard empiric antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided needle biopsy of the prostate (TRUS-BP), as well as to assess rate of fecal carriage of Fluoroquinolone-resistant Enterobacterales FQRE.
Patients and methods
We prospectively analyzed data that randomized 157 patients within two groups: (G1) TAP according to rectal swab performed 10 days before PB; (G2): empirical antibiotic prophylaxis with ciprofloxacin. Prevalence of FQRE digestive carriage and risk factors were investigated. Incidence of infectious complications after (TRUS-BP) in each group was compared.
Results
G2 included 80 patients versus 77 in G1. There was no difference between the two groups regarding age, diabetes, prostate volume, PSA, number of biopsy cores, and risk factors for FQRE. In G2, the prevalence of FQRE digestive carriage was 56.3% all related to E. coli species. In the case of digestive carriage of FQRE, TAP according to the rectal swab culture with third-generation cephalosporins was performed in 73.3%. Patients with FQRE had history of FQ use within the last 6 months in 17.8% (p = 0.03). Rate of febrile urinary tract infection after PB was 13% in G1 and 3.8% in G2 (p = 0.02).
Conclusions
Incidence of FQ resistance in the intestinal flora of our local population was prevalent. Risk factor for resistance was the use of FQ within the last 6 months. TAP adapted to rectal swab, mainly with third-generation cephalosporins, significantly reduced the rate of infectious complications after (TRUS-BP).
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Data availability
The data underlying this article will be shared on reasonable request to the corresponding author.
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A. B conceptualization of the protocol, choice of methods, rectal swab supervising, results interpretations, check and manuscript draft, and revising; A. R design of microbiological analysis, strains isolation and identification, antibiotic susceptibility testing, data analysis, interpretations, and check and revising of manuscript; A. S rectal swab monitoring, resources validation, data analysis, and writing of the original draft of manuscript; S. Z, M. C, H. A, A.D: collect rectal swabs, patient follow-up, and statistical analysis. F. A revised the draft paper critically for important intellectual content; Pr. I. B-BB and Pr. MR BS supervisor and main reviewer and editor of the final version of the manuscript. All authors have read and agreed to the published version of the manuscript.
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Ethical approval
Ethical approval for this study protocol, the patient information sheet, and the informed consent form were approved by the local Ethics Committee of the Charles Nicolle Hospital: CHN Ethics Committee member of the Office for the Protection of Human Research (OHRP) in the United States recognized under the number FWA:FWA00032748/IID:IORG0011243.
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The study involves Humans Participants and has been carried out in accordance with the ethical standards.
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All patients undergoing TRUS-BP were included following informed consent.
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Bouzouita, A., Rehaiem, A., Saadi, A. et al. Antimicrobial prophylaxis protocol based on rectal swab culture before prostate biopsy to prevent infectious complications: a prospective randomized comparative study. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-03998-7
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DOI: https://doi.org/10.1007/s11255-024-03998-7