A single 80 mg intravenous gentamicin dose prior to prostate needle biopsy does not reduce procedural infectious
Jay D Raman1, Chris Rjepaj1, Christopher Otteni1
1Penn State Milton S. Hershey Medical Center, Department of Urology, Hershey, USA.
Introduction:
Rates of infectious complications continue to increase following transrectal ultrasound guided prostate needle biopsy (TRUS PNB). Administration of a parenteral antibiotic at time of procedure represents one potential prophylaxis strategy. The efficacy of this practice remains incompletely defined.
Material And Methods:
Our institutional TRUS PNB database was reviewed to identify consecutive men undergoing a biopsy over a 48-month period. The peri-operative intravenous antibiotic regimen (when used) included gentamicin 80 mg administered intravenously (IV) 30 minutes prior to biopsy. The incidence of infections post-biopsy was compared between patients receiving oral alone versus IV plus oral antibiotic prophylaxis.
Results:
182 of 522 men (34.9%) included in this study received peri-procedural IV gentamicin at time of TRUS PNB, with a significant increase in utilization during the study time period (p <0.001). In total, 39 patients (7.5%) developed an infectious complication post-biopsy. No differences in infection rates were observed between patients receiving only oral prophylaxis (27 of 340, 7.9%) versus those receiving oral with IV gentamicin (12 of 182, 6.6%) (p = 0.73).
Conclusions:
In this 4-year cohort analysis, a single peri-procedural dose of 80 mg of intravenous gentamicin failed to confer a reduction in infectious complications following prostate needle biopsy. Such data underscore the need to better understand the dose, route, and type of antimicrobial therapy to limit procedural infections.
Insights
A single dose of intravenous gentamicin before prostate needle biopsy did not reduce infection rates. Further research is needed on optimal antibiotic strategies to prevent infectious complications after prostate biopsies.
Area of Science:
- Urology
- Infectious Diseases
- Pharmacology
Background:
- Infectious complications after transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing.
- Parenteral antibiotics are a potential prophylaxis strategy, but their efficacy is not well-defined.
Purpose of the Study:
- To evaluate the efficacy of peri-procedural intravenous gentamicin in reducing infectious complications following TRUS PNB.
Main Methods:
- A retrospective review of a TRUS PNB database over 48 months.
- Compared infection rates between patients receiving oral antibiotics alone versus oral plus intravenous gentamicin (80 mg IV 30 minutes prior to biopsy).
Main Results:
- 34.9% of patients received peri-procedural IV gentamicin, with increased utilization over time.
- Overall infection rate was 7.5% (39/522).
- No significant difference in infection rates was observed between the oral-only group (7.9%) and the oral plus IV gentamicin group (6.6%) (p=0.73).
Conclusions:
- A single 80 mg IV dose of gentamicin prior to TRUS PNB did not reduce infectious complications.
- Further investigation into optimal antibiotic dose, route, and type is necessary to mitigate procedural infections.
