Infection is one of the most feared complications following transrectal ultrasound-guided prostate biopsy (TRUSPBx). The role of antibiotic prophylaxis before the procedure is well established and most of guidelines suggest fluoroquinolones as prophylatic agents of choice. However, the crescent reports of infection with fluoroquinolone-resistant Escherichia coli (E. coli) following these procedures raise concern about the best prophylactic scheme. We evaluate the incidence of fever following TRUSPBx before and after change the standard antibiotic prophylaxis from Ciprofloxacin to Ceftriaxone in a 300-bed private Hospital in Sao Paulo, Brazil, which has a 30% prevalence of E. coli fluoroquinolone-resistant in urine samples.
Post-biopsy fever was detected by phone call surveillance during all the study period. TRUSPBx prophylaxis with IV Ceftriaxone 2g 30 minutes before the procedure was implemented in March/2014. We analyzed the time series from June/2012 to February/2015 and the three months moving average was used to reduce irregularities. Two months were excluded from analysis because it was not possible to reach the patients by phone call surveillance. We conducted the Durbin-Watson test to evaluate the presence of autocorrelation and the Prais-Winsten procedure for generalized linear regression. Trends or associations were considered statistical significant when the regression coefficients had the 95% confidence interval (CI95%) different from zero (p<0.05). Data analysis was performed using Stata 14.0.
During the study period, 744 TRUSPBx were performed in the service: 377 during the period of Ciprofloxacin protocol and 367 during the period of Ceftriaxone protocol. The time series analysis showed stationary trend in the pre and post-Ceftriaxone periods. The mean of post-biopsy fever incidence rate during the Ceftriaxone period (0.7%) was significantly lower than during the Ciprofloxacin period (6.4%): CI95% -10.3 to -0.65; p=0.028. (Fig. 1). In addition, the costs regarding both schemes were similar.
Ceftriaxone was more effective than Ciprofloxacin as prophylaxis pre TRUSPBx and should be considered in scenarios with high prevalence of fluoroquinolone resistance.
B. G. D. Miranda,
M. L. D. N. Moura, None
M. C. Martinez, None
L. D. P. G. Duarte, None
A. M. Costa, None
J. A. Nunes, None
M. L. N. Biancalana, None