Urosepsis after transrectal ultrasonography-guided prostate biopsy: Reaudit following a shortened antibiotic prophylaxis regimen

摘要

We read with interest this journal's recent Leading article concerning the national burden of infections after transrectal ultrasonography-guided prostate biopsy (TRUSgpb)1 and the need for urgent action to reduce infectious complications. The authors discuss a number of possible strategies, including alterations in antimicrobial prophylaxis. We recently performed an audit cycle to specifically assess one such strategy.In 2009, we published our Trust's post-TRUSgpb infection data for theyear October 2007 -September 2008.2 Although the incidence of urosepsis [7/256 (2.7%) biopsies, including 4 (1.6%) bacteraemias] was not out of keeping with other reports, our prime concern was the multiresistant nature of the pathogens, with 100% ciprofloxacin resistance and 57% extended-spectrum beta-lactamase (ESBL) production. During this time, the antibiotic prophylaxis regimen comprised ciprofloxacin and metronidazole for 1 day prior to biopsy and 2 days post-biopsy. To lessen effects on the bowel flora before the procedure, and to align with protocols used in other centres, prophylaxis was altered to begin just 2 h before biopsy (a reduction of two doses of ciprofloxacin and three of metronidazole). Our infection rate was then reaudited over 2 years.