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使用直肠培养选择性查介质进行针对性抗菌预防的意义跨直肠前列腺活检之前的选择性查介质:多中心,随机对照试验

Takuya Sadahira¹, Takanori Sekito¹, Yuki Maruyama¹

¹Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; The Japanese Research Group for Urinary Tract Infection (JRGU), Nishinomiya, Japan.

|December 18, 2024

概括

在前列腺活检之前查直肠培养可能有助于预防细菌性前列腺炎. 针对性抗生素,如 piperacillin/tazobactam,在发现耐药细菌时是有效的.

科学领域:

泌尿器科泌尿器科泌尿器科泌尿器科
传染性疾病传染性疾病
微生物学微生物学

背景情况:

跨直肠前列腺活检 (TRPB) 存在感染并发症的风险,包括急性细菌性前列腺炎.
抗微生物预防是标准的,但抗药性增加需要优化策略.
在直肠培养中选特定的耐药细菌可以指导向预防.

研究的目的:

评估由选择性直肠培养指导的抗菌预防在预防TRPB后急性细菌性前列腺炎的有效性.
评估选择性介质在检测耐诺 (FQ) 或扩展光谱β-乳糖酶 (ESBL) 生产大肠杆菌 (大肠杆菌) 的准确性.

主要方法:

一个多中心,随机对照试验,涉及403名接受低感染风险的TRPB患者.
患者被随机分配到培养组 (CG),根据直肠培养结果接受向预防,或非培养组 (NCG).
在CG中的预防包括针对FQ耐药/产生ESBL的大肠杆菌的piperacillin/tazobactam或其他人的levofloxacin;NCG接受了levofloxacin.

主要成果:

在TRPB后前列腺炎的总发病率为1.1% (4/373名患者).
发生率在CG中为1.6%,在NCG中为0.5%,没有统计学上显著的差异 (P=.3).
在CG中,阳性直肠培养的患者中没有发生前列腺炎病例. 选择性介质显示出高灵敏度 (98.1%) 和特异性 (94.7%).

结论:

用选择性直肠培养进行活检前查可能在预防TRPB后的前列腺炎方面提供额外的价值,特别是指导抗生素选择.
当检测到耐FQ或产生ESBL的大肠杆菌时,piperacillin/tazobactam是预防的可行选择.
使用的选择性介质在识别关键耐药病原体方面表现出高准确性.

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