Comparison of a combined regimen of fosfomycin and ciprofloxacin with ciprofloxacin alone as antimicrobial prophylaxis for transrectal prostate biopsy in the era of high fluoroquinolone-resistant rectal flora

摘要

BackgroundTo assess the prophylactic effect of fosfomycin (FM) and ciprofloxacin combinations for infectious complications of transrectal ultrasound-guided prostate biopsy (TRUSPB) compared to that of ciprofloxacin alone.MethodsIn total, 1,578 patients were enrolled and were divided into two groups according to the prophylactic antibiotics. Group 1 (n?=?1234) received ciprofloxacin on the day of the biopsy and for an additional 1–2?days, whereas Group 2 (n?=?334) was given FM in addition to ciprofloxacin in the same manner as Group 1. The primary outcome was overall infectious complications within 1?month of TRUSPB. The secondary outcome was the risk factors of infectious complications after TRUSPB.ResultsInfectious complications occurred in 31?patients (2.5%) and 1?patient (0.3%) in Groups 1 and 2, respectively. Our results indicated that fluoroquinolone (FQ) and FM significantly reduced the risk of infectious complications compared to FQ (relative risk: 0.12; 95% confidence interval 0.02–0.87,P=?0.015). Based on the multivariate analysis, previous antibiotic exposure (odds ratio [OR]?=?3.59,P=?0.026), and the addition of FM (OR?=?0.12,P=?0.038) were associated with infectious complications. Based on the rectal swab, FQ resistance was 28.0% (n?=?294) in total. FQ resistance in the FQ and FM group was higher than that in the FQ group (n?=?178, 54.9% vs. n?=?116, 16.0%,P