ISSN : 2146-3123
E-ISSN : 2146-3131

Comparison of Single & Prolonged Fluoroquinolone Prophylaxis and Risk Factors for Infectious Complications After Transrectal Prostate Biopsy
Arif Kalkanlı1, Cem Tuğrul Gezmiş1, Arif Özkan1, Nusret Can Çilesiz1, Fatih Yanaral2, Memduh Aydın1, Zafer Tandoğdu3
1Clinic of Urology, İstanbul Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
2Clinic of Urology, İstanbul Haseki Training and Research Hospital, İstanbul, Turkey
3Department of Urology, Northern Institute for Cancer Research Newcastle University, Newcastle, United Kingdom
DOI : 10.4274/balkanmedj.2018.0477

Background: The ideal prophylaxis duration for transrectal ultrasonography guided prostate biopsy (TRUS-bx) is not well defined.
Aims: In our study we aim to compare the infectious complications of TRUS-bx with and without extended antibiotic prophylaxis. The secondary aim was to evaluate risk factors for infectious complications.
Study Design: Prospective observational study.
Methods: In our study, 400 patients who underwent TRUS-bx were recruited. Patients received either 750 mg oral ciprofloxacin 60 minutes before the procedure or 500 mg oral ciprofloxacin 2 times a day for a duration of 7 days with the initial dose administered 24 hours prior to the procedure. All patients were followed for 4 weeks after the TRUS-bx procedure for infectious complications. A screening of urine was carried out in all patients on the 3rd and 7th day after the procedure.Medical histories of all patients were collected prior to biopsy. These include; hospitalization, urethral catheterization or UTI within in the past 12 months, antibiotic use within the last 3 months, prior urinary tract interventions, previous TRUS-bx and Charlson comorbidity indexes. Ultrasound guided biopsy was carried out using General Electric's 7 Mhz transrectal ultrasound device in the left decubitus position. Patients received one of the two ciprofloxacin based prophylaxis regimens. Subsequent to TRUS-bx all patients were followed for 30 days. Further follow-up of patients were carried out on the second and fourth weeks after TRUS-bx, and symptoms such as dysuria, rectal bleeding, fever, hematospermia, hematuria, and pollakiuria were recorded.
Results: Both groups had similar baseline characteristics and medical history. Infectious complication rates within the 4 week follow-up were similar in both groups (single dose: 3% vs prolonged: 3%) (p>0,05). İn both groups, infectious complications were significantly increased at previous antibiotic usage. (single: p=0,028; prolonged: p=0,040). Non-infectious complication ratios didn't vary significantly (p>0,05).
Conclusion: Our study suggests that pre-operative single dose 750 mg oral ciprofloxacin compared to 7 days prolonged treatment had similar infectious complication outcomes in patients undergoing TRUS-bx. Use of antibiotics within the last 3 months increases the risk for post-TRUS-bx infectious complications.

Keywords : Urinary tract infection, transrectal prostate biopsy, oral antibiotic prophylaxis, ciprofloxacin prophylaxis, previous antibiotic usage
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