Comparison of Fluoroquinolones and Other Antibiotic Prophylaxis Regimens for Preventing Complications in Patients Undergoing Transrectal Prostate Biopsy
Gabriele Tulone,
Sofia Giannone,
Piero Mannone,
Alessio Tognarelli,
Tommaso Di Vico,
Rosa Giaimo,
Alessandro Zucchi,
Marta Rossanese,
Alberto Abrate,
Nicola Pavan,
Francesco Claps,
Vincenzo Ficarra,
Riccardo Bartoletti,
Alchiede Simonato
Affiliations
Gabriele Tulone
Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy
Sofia Giannone
Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy
Piero Mannone
Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy
Alessio Tognarelli
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Tommaso Di Vico
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Rosa Giaimo
Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy
Alessandro Zucchi
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Marta Rossanese
Urology Section, Department of Human and Pediatric Pathology “Gaetano Barresi”, University of Messina, 98168 Messina, Italy
Alberto Abrate
Urology Unit, Department of Surgery, ASST Valtellina e Alto Lario, 23100 Sondrio, Italy
Nicola Pavan
Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
Francesco Claps
Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
Vincenzo Ficarra
Urology Section, Department of Human and Pediatric Pathology “Gaetano Barresi”, University of Messina, 98168 Messina, Italy
Riccardo Bartoletti
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
Alchiede Simonato
Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy
Our study aimed to compare the incidence of infective complications after transrectal ultrasound-guided prostate biopsy (TRUSBx) when adopting different antimicrobial prophylaxis regimens. A multi-institutional cohort of 1150 patients who underwent TRUSBx was retrospectively analyzed. Procedures were performed between 2017 and 2019 (before and after the EMA warning about the use of fluoroquinolones for the antibiotic prophylaxis of patient candidates to TRUSBx). The primary endpoint was the occurrence of infective complications, including sepsis and/or fever. The population was stratified according to the antibiotic prophylaxis adopted: fluoroquinolones (levofloxacin, ciprofloxacin, prulifloxacin), cephalosporins (cefixime, ceftriaxone) or trimethoprim/sulfamethoxazole. Univariable and multivariable binomial logistic regression models were used to assess the odds ratio (OR) with 95% confidence interval (CI) testing of the risk of infective complication after adjusting for each prebiopsy covariate. In total, 478 (41.6%) patients received fluoroquinolone-based prophylaxis. Among these, 443 (38.5%), 25 (2.2%) and 10 (0.9%) patients received levofloxacin prophylaxis, ciprofloxacin and prulifloxacin, respectively while 14.6% received cefixime, 20.7% received the comedication of ceftriaxone/fosfomycin and 23.1% received trimethoprim/sulfamethoxazole. The trimethoprim/sulfamethoxazole and fluoroquinolone regimens were significantly associated with a lower risk of infective complications (OR 0.15, 95% CI 0.03–0.48, p = 0.003 and OR 0.17, 95% CI 0.06–0.43, p p = 0.04) and fluoroquinolone (OR 0.07, 95% CI 0.00–0.70, p = 0.048) prophylaxis were associated with a lower risk of infective sequelae. Fluoroquinolone-based prophylaxis was associated with a lower risk of infective complications after TRUSBx compared to other prophylaxis regimens although its clinical application was recently forbidden by European Medical Agency restrictions.
