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Adding amikacin to fluoroquinolone-based antimicrobial prophylaxis reduces prostate biopsy infection rates

Deepak Batura1, G Gopal Rao1, Peder Bo Nielsen1

  • 1Departments of Urology and *Microbiology, Northwick Park Hospital, London, and †Statistics, Modelling and Bioinformatics Department, Centre of Infections, Health Protection Agency, UK.

BJU International
|October 30, 2010
PubMed
Abstract

Insights

Adding amikacin to fluoroquinolone prophylaxis significantly reduced infections after prostate biopsies. This strategy is beneficial in areas with high fluoroquinolone resistance, improving patient safety during transrectal ultrasonography-guided biopsies.

Area of Science:

  • Urology
  • Infectious Diseases
  • Pharmacology

Background:

  • Transrectal ultrasonography-guided prostate biopsy (TGB) carries a risk of infection.
  • Antimicrobial prophylaxis is standard, but rising fluoroquinolone resistance poses a challenge.

Purpose of the Study:

  • To evaluate the effectiveness of adding amikacin to fluoroquinolone-based prophylaxis for preventing TGB-associated infections.
  • To assess the impact on urinary tract infections (UTIs) and bacteraemia rates.

Main Methods:

  • A comparative study analyzing infection rates before (2006) and after (2007-2008) adding amikacin to prophylaxis.
  • Prophylaxis included ciprofloxacin, co-amoxiclav, and metronidazole; co-amoxiclav was later discontinued.
  • Amikacin was added to the regimen in 2007-2008.

Main Results:

  • Infection rates decreased from 3.9% (11/281) before amikacin to 1.4% (6/590) after its addition.
  • Bacteraemia rates significantly reduced (P=0.002) with amikacin inclusion.
  • A trend towards reduced UTIs was observed, though not statistically significant at the conventional level.

Conclusions:

  • Adding amikacin to fluoroquinolone prophylaxis significantly lowers infection rates following TGB.
  • This strategy is particularly effective in regions with high fluoroquinolone resistance.
  • Amikacin enhances the safety of prostate biopsy procedures.

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