Reduction in hospital admissions with the addition of prophylactic intramuscular ceftriaxone before transrectal ultrasonography-guided prostate biopsies - Abstract

OBJECTIVE: To evaluate the hospitalization rates in 2 pre-prostate biopsy antibiotic protocols.

METHODS: Two prebiopsy protocols were compared. CiproAlone required ciprofloxacin 500 mg twice daily starting 1 day before biopsy and continuing for 3 days after biopsy (4 days total). Diabetic patients were prescribed ciprofloxacin for 4 days after biopsy. CiproCeft required 1 dose of oral ciprofloxacin 500 mg 1 hour before the biopsy and ceftriaxone 1 g intramuscular at the time of the biopsy. Hospitalization rates between the CiproAlone vs CiproCeft protocols were examined.

RESULTS: A total of 4134 biopsies were identified-2093 in the CiproAlone cohort and 2041 in the CiproCeft cohort. The post-prostate biopsy infection hospitalization rate was 0.6% (14 patients) in the CiproAlone group vs 0.0% (0 patients) in the CiproCeft group (P < .0001). Of the patients hospitalized, 12 fit systemic inflammatory response syndrome (SIRS) criteria. Eight of 14 hospitalized patients fit the sepsis (SIRS and source of infection) criteria. Positive cultures (urine and/or blood) resulted from 71% (n = 10) of hospitalized patients. Antibiotic resistance was analyzed. Diabetes mellitus was associated with hospitalization after prostate biopsy (P = .01) in our population, but there was no difference between the 2 groups in the rates of diabetes mellitus (P = .46). Patient age, prostate-specific antigen level, number of biopsy cores obtained, race, and previous antibiotics exposure were not found to be independent predictors of post-transrectal ultrasonography biopsy hospitalization for infection using a multivariate regression analysis.

CONCLUSION: A prophylactic prebiopsy protocol including 2 classes of antibiotics, single-dose ciprofloxacin, and singe-dose intramuscular ceftriaxone reduced post-transrectal ultrasonography biopsy rates of hospitalizations compared to oral ciprofloxacin alone.

Written by:
Luong B, Danforth T, Visnjevac O, Suraf M, Duff M, Chevli KK.   Are you the author?
Department of Urology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY; Department of Urology, the Western New York Urology Associates, LLC, Cheektowaga, NY; Department of Radiation Oncology, the Cancer Care of Western New York, Cheektowaga, NY.  

Reference: Urology. 2015 Mar;85(3):511-6.
doi: 10.1016/j.urology.2014.10.047

PubMed Abstract
PMID: 25596154 Prostate Cancer Section