Antibiotic prophylaxis for transrectal prostate biopsy-a new strategy

Area of Science:

• Urology
• Infectious Diseases
• Pharmacology

Background:

• Fluoroquinolones are standard prophylaxis for transrectal ultrasound-guided prostate biopsy (TRUBP).
• Rising fluoroquinolone resistance necessitates alternative prophylactic strategies.
• Pivmecillinam and amoxicillin/clavulanic acid combination offers broad-spectrum coverage against TRUBP pathogens.

Purpose of the Study:

• To evaluate the efficacy of pivmecillinam and amoxicillin/clavulanic acid as prophylaxis for TRUBP.
• To compare infection rates and bacterial resistance patterns between fluoroquinolone prophylaxis and the novel combination regimen.

Main Methods:

• Retrospective cohort study of 2624 men undergoing TRUBP.
• Three groups: ciprofloxacin prophylaxis, pivmecillinam/amoxicillin-clavulanic acid prophylaxis, and extended pivmecillinam/amoxicillin-clavulanic acid prophylaxis.
• Analysis of post-biopsy infection rates, including bacteremia and specific pathogens.

Main Results:

• Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis were the most common pathogens.
• Extended pivmecillinam/amoxicillin-clavulanic acid prophylaxis significantly reduced bacteremia rates (0.9%) compared to ciprofloxacin (1.8%) and standard combination (3.7%).
• A decrease in ESBL-producing Enterobacteriaceae was observed with the pivmecillinam/amoxicillin-clavulanic acid regimen (5.9%) versus ciprofloxacin (8.1%).

Conclusions:

• The combination of pivmecillinam and amoxicillin/clavulanic acid is a clinically effective and ecologically favorable alternative to ciprofloxacin for TRUBP prophylaxis.
• Extended prophylaxis with this combination regimen further enhances its protective effect.
• This approach may help mitigate the growing problem of antibiotic resistance in urological procedures.