Effectiveness of fosfomycin-based antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: A
Do Gyeong Lim1, Seung Il Jung2, Eu Chang Hwang1
1Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
Purpose:
Recent studies have highlighted increasing infectious complications due to fluoroquinolone (FQ)-resistant organisms in men undergoing transrectal ultrasound-guided prostate biopsy (TRUSPB). This study investigated whether fosfomycin (FM)-based antibiotic prophylaxis reduces infections after TRUSPB and identified risk factors for infective complications.
Materials And Methods:
A multicenter study was conducted in the Republic of Korea from January 2018 to December 2021. Patients undergoing prostate biopsy with FQ or FM-based prophylaxis were included. The primary outcome was the post-biopsy infectious complication rate after FQ (group 1) or FM-based antibiotic prophylaxis with FM alone (group 2) or FQ and FM (group 3). Risk factors for infectious complications after TRUSPB were secondary outcomes.
Results:
Patients (n=2,595) undergoing prostate biopsy were divided into three groups according to the type of prophylactic antibiotics. Group 1 (n=417) received FQ before TRUSPB. Group 2 (n=795) received FM only and group 3 (n=1,383) received FM and FQ before TRUSPB. The overall post-biopsy infectious complication rate was 1.27%. The infectious complication rates were 2.4%, 1.9%, and 0.5% in groups 1, 2, and 3, respectively (p=0.002). In multivariable analysis, predictors of post-biopsy infectious complications included an association with health care utilization (adjusted odds ratio [OR], 4.66; 95% confidence interval [CI], 1.74-12.4; p=0.002) and combination antibiotic prophylaxis (FQ and FM) (adjusted OR, 0.26; 95% CI, 0.09-0.69; p=0.007).
Conclusions:
In comparison with monotherapy with FM or FQ, combination antibiotic prophylaxis (FQ and FM) showed a lower rate of infectious complications after TRUSPB. Utilization of health care was an independent risk factor for infectious complications after TRUSPB.
Insights
Combining fluoroquinolone (FQ) and fosfomycin (FM) antibiotics significantly reduced infectious complications after transrectal ultrasound-guided prostate biopsy (TRUSPB). Healthcare utilization was identified as a key risk factor for these post-biopsy infections.
Area of Science:
- Infectious Diseases
- Urology
- Pharmacology
Background:
- Increasing infectious complications after transrectal ultrasound-guided prostate biopsy (TRUSPB) are linked to fluoroquinolone (FQ)-resistant organisms.
- Antibiotic prophylaxis is crucial to prevent these infections, but resistance patterns necessitate evaluating alternative strategies.
Purpose of the Study:
- To investigate if fosfomycin (FM)-based antibiotic prophylaxis reduces infections following TRUSPB.
- To identify independent risk factors contributing to infective complications after TRUSPB.
Main Methods:
- A multicenter study in South Korea (2018-2021) included 2,595 patients undergoing prostate biopsy.
- Patients received either FQ monotherapy (Group 1), FM monotherapy (Group 2), or combination FQ and FM prophylaxis (Group 3).
- Infectious complication rates and risk factors were analyzed.
Main Results:
- The overall post-biopsy infectious complication rate was 1.27%.
- Infectious complication rates were 2.4% (FQ), 1.9% (FM), and 0.5% (FQ+FM), with the combination therapy showing significantly lower rates (p=0.002).
- Healthcare utilization (aOR 4.66) and combination prophylaxis (aOR 0.26) were significant predictors in multivariable analysis.
Conclusions:
- Combination antibiotic prophylaxis with fluoroquinolone and fosfomycin demonstrates superior efficacy in reducing infectious complications post-TRUSPB compared to monotherapy.
- Healthcare utilization emerged as an independent risk factor for post-biopsy infectious complications.
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