EAU 2018: Culture-based Targeted Antibiotic Prophylaxis By Β-lactams Alone is Not Sufficient to Prevent Infective Complications After Transrectal Prostate Biopsy

Copenhagen, Denmark (UroToday.com) Dr. Nasu, a clinical urologist from the Okayama Rosai Hospital, Dept. of Urology, presented on the efficacy of targeted antibiotic prophylaxis (TAP) by use of beta-lactams to prevent infective complications (IC) after transrectal ultrasonography guided prostate biopsy (TRPB) in patients with quinolone-resistant E. coli (QREC). Quinolone-resistant bacteria have become increasingly prevalent; therefore new prophylactic approaches are needed for TRPB. TAP, in the past, has been shown to be a valid preventer of IC after TRPB, if proper bacteria susceptible antibiotics are used.

In this study, 337 males, who planned to undergo TRPB, obtained rectal swabs to identify bacteria present in the rectum, thus facilitating culture-based TAP. Among the patient population, 45 were found to have QREC and were divided into two groups. Group 1, consisted of 17 patients who received amikacin (AMK) 200mg + levofloxacin (LVFX) 500mg, while group 2 contained 28 patients who were prescribed susceptible beta-lactams alone. In the group of patients without QREC, LVFX 500mg only was prescribed.

Dr. Nasu reported a significantly increased number of QREC prevalence in group 2, along with a higher incidence of febrile IC. Although patients with QREC in this group were given beta-lactam antibiotics susceptible to isolates attained from their rectal swabs, 28.6% still experienced febrile IC in comparison to only 5.9% in group 1.

As a result, it was determined that AMK is susceptible for QREC and has synergistic effects when used in combination with LVFX, therefore reinforcing LVFX based prophylaxis. Dr. Nasu further explained that this observation may be due to the increased permeability of prostate cells to LVFX and AMK and a lower permeability to beta-lactams.

In conclusion, TAP using LVFX was sufficient for IC prevention after TRPB in patients without QREC. However, LVFX used in combination with AMK showed increased efficacy, while beta-lactams alone were less effective.

Speaker: Y. Nasu

Authors: Nasu Y., Kosaka N., Tanaka D., Sugimoto A., Takamoto A.

Written by: Whitney Zhang, Department of Urology, University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark