PMID- 28122053
OWN - NLM
STAT- MEDLINE
DCOM- 20170818
LR  - 20190109
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 1
DP  - 2017
TI  - Rectal Culture-Guided Targeted Antimicrobial Prophylaxis Reduces the Incidence of
      Post-Operative Infectious Complications in Men at High Risk for Infections
      Submitted to Transrectal Ultrasound Prostate Biopsy - Results of a
      Cross-Sectional Study.
PG  - e0170319
LID - 10.1371/journal.pone.0170319 [doi]
AB  - The role of rectal culture-guided antimicrobial prophylaxis (TAP) in reducing
      infectious complications (IC) after transrectal-ultrasound prostate biopsy
      (TRUSPBx) is conflicting. We assessed the prevalence of IC in a cohort of men at 
      high risk for IC submitted to TRUSPBx and treated with either TAP or empirical
      prophylaxis (EAP). Data from 53 patients at high risk for IC undergoing TRUSPBx
      were collected. Patients who did not receive a rectal swab (RS) were treated with
      EAP with fluoroquinolones (FQs). Of those who received the RS, patients with
      FQ-susceptible organisms received ciprofloxacin while those with FQ-resistant
      organisms received TAP. Office visits were scheduled to investigate the rate of
      complication at day 7 and 30 after TRUSPBx. Comorbidities were scored with the
      Charlson Comorbidity Index (CCI). Descriptive statistics and logistic regression 
      models detailed the association between clinical parameters and IC rate. Out of
      53 men, 17 (32.1%) had RS while 36 (67.9%) did not. All RS cultures were positive
      for E. Coli and 4 (23.5%) reported FQ-resistant pathogens. Considering risk
      factors for IC, no difference was found in terms of CCI, rate of diabetes, UTIs
      or recent antibiotic utilization between groups. Overall, 12 (22.6%) men reported
      IC, with a greater proportion of them belonging to the group treated with EAP
      (30.6% vs 5.9%; p = 0.045). Of these, 9 (25.0%) patients, all treated with EAP,
      developed post biopsy UTIs. E. Coli sustained all UTIs and 7 (77.7%) were FQ
      resistant. At multivariable analysis, CCI>/=1, a history of UTIs/prostatitis and 
      recent antibiotic utilization (all p<0.04) were the most powerful predictors for 
      ICs. In conclusion, we found that compared to EAP, TAP significantly reduces ICs,
      in men at high risk for post TRUSPBx IC. Patients at risk for IC, especially
      those with recent antibiotic utilization, CCI>/=1 and a history of
      UTIs/prostatitis before biopsy, could benefit from TAP.
FAU - Boeri, Luca
AU  - Boeri L
AD  - Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore
      Policlinico, University of Milan, Milan, Italy.
FAU - Fontana, Matteo
AU  - Fontana M
AD  - Department of Urology, Ospedale San Paolo, University of Milan, Milan, Italy.
FAU - Gallioli, Andrea
AU  - Gallioli A
AD  - Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore
      Policlinico, University of Milan, Milan, Italy.
FAU - Zanetti, Stefano Paolo
AU  - Zanetti SP
AD  - Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore
      Policlinico, University of Milan, Milan, Italy.
FAU - Catellani, Michele
AU  - Catellani M
AD  - Department of Urology, Ospedale San Paolo, University of Milan, Milan, Italy.
FAU - Longo, Fabrizio
AU  - Longo F
AD  - Department of Urology, Ospedale San Paolo, University of Milan, Milan, Italy.
FAU - Mangiarotti, Barbara
AU  - Mangiarotti B
AD  - Department of Urology, Ospedale San Paolo, University of Milan, Milan, Italy.
FAU - Montanari, Emanuele
AU  - Montanari E
AD  - Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore
      Policlinico, University of Milan, Milan, Italy.
LA  - eng
PT  - Evaluation Studies
PT  - Journal Article
DEP - 20170125
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Anti-Bacterial Agents)
RN  - 5E8K9I0O4U (Ciprofloxacin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Bacterial Agents/adverse effects/therapeutic use
MH  - Antibiotic Prophylaxis/*methods
MH  - Biopsy, Needle/*adverse effects/methods
MH  - Ciprofloxacin/therapeutic use
MH  - Comorbidity
MH  - Cross-Sectional Studies
MH  - Diabetes Mellitus/epidemiology
MH  - Disease Susceptibility
MH  - Drug Resistance, Multiple, Bacterial
MH  - Enterobacteriaceae/drug effects/growth & development/*isolation & purification
MH  - Enterobacteriaceae Infections/etiology/*prevention & control
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Prostate/*pathology
MH  - Prostatitis/etiology/*prevention & control
MH  - Rectum/*microbiology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Ultrasonography, Interventional
MH  - Urinary Tract Infections/etiology/*prevention & control
PMC - PMC5266328
COIS- The authors have declared that no competing interests exist.
EDAT- 2017/01/26 06:00
MHDA- 2017/08/19 06:00
CRDT- 2017/01/26 06:00
PHST- 2016/10/21 00:00 [received]
PHST- 2017/01/03 00:00 [accepted]
PHST- 2017/01/26 06:00 [entrez]
PHST- 2017/01/26 06:00 [pubmed]
PHST- 2017/08/19 06:00 [medline]
AID - 10.1371/journal.pone.0170319 [doi]
AID - PONE-D-16-40938 [pii]
PST - epublish
SO  - PLoS One. 2017 Jan 25;12(1):e0170319. doi: 10.1371/journal.pone.0170319.
      eCollection 2017.