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MP11-19: Targeted antibiotic prophylaxis by β-lactams based on rectal swab culture is not sufficient to prevent infective complications after transrectal prostate biopsy

Friday, May 12
1:00 PM - 3:00 PM
Location: BCEC: Room 151

Presentation Authors: Yoshitsugu Nasu*, Tadashi Murata, Morito Sugimoto, Atsushi Takamoto, Okayama, Japan

Introduction: The targeted antibiotic prophylaxis by susceptible antibiotics based on the rectal swab culture has been reported to be effective for prevention of infective complications (IC) after transrectal ultrasonography guided prostate biopsy (TRPB). We evaluated the efficacy of the targeted antibiotic prophylaxis by β-lactams for the prevention of IC after TRPB among patients with quinolone-resistant (QR) strains.

Methods: From January 2010 to December 2015, a total of 337 men who underwent TRPB were included. Prior to TRPB, rectal swabs were cultured and determined the possession of QR strains. Isolated bacteria was determined QR when their minimum inhibitory concentration of levofloxacin (LVFX) was 4 μg/mL or above. Patients were divided into two study groups. Group 1 consisted of 176 patients from January 2010 to March 2013 and group 2 consisted of 161 patients from April 2013 to December 2015. For patients without the possession of QR strains, single oral 500mg of LVFX was received 2 hours before TRPB. Patients with QR strains of the group 1 received LVFX plus amikacin and those of the group 2 received intravenous β-lactams for which isolates were susceptible. All biopsies were carried out through a standard 10-core approach with local anesthesia. The patients were followed up for 2 weeks after TRPB and febrile IC were recorded.

Results: Overall the prevalence of QR strains was 13.4% (45/337). That of the group 1 and the group 2 was 9.7% (17/176) and 17.4% (28/161), respectively. A total of 14 patients (4.2%) had post-TRPB fever in this study. The incidence of febrile IC of the group 1 was 1.7% (3/176) and that of the group 2 was 6.8% (11/161). Forty-five patients with QR strains were complied with targeted antibiotic prophylaxis. In the group 1, only one (5.9%) out of 17 patients with QR strains had febrile IC. In the group 2, although they received β-lactam antibiotics which were susceptible to isolates from rectal swab culture, 8 (28.6%) out of 28 patients with QR strains had febrile IC.

Conclusions: In the group 1, few patients with both quinolone-sensitive and QR strains had febrile IC. In the group 2, the incidence of febrile IC has increased, especially among patients with QR strains who received susceptible β-lactams for prophylaxis. The targeted antibiotic prophylaxis by β-lactams alone was less effective among patients with QR strains. Facing the increase of multi-drug resistant bacteria in the rectal flora, new tactics to prevent post-TRPB febrile IC will be needed.

Source Of Funding: none

Yoshitsugu Nasu

CURRICULUM VITAE

YOSHITSUGU NASU, M.D.,Ph.D.


PRESENT ADDRESS :
OFFICE : Department of Urology
Okayama Rosai Hospital
1-10-25,Chikkou Midori-Machi, Okayama 7028055, Japan
Tel; +81-86-262-0131
Fax; +81-86-262-3391
Email; khscuro@hotmail.com
HOME : 11-6-901, Daiku-omote-machi, Okayama 7000912, Japan
Tel; +81-86-238-3418

PRESENT POSITION :
Head, Department of Urology
Okayama Rosai Hospital

PERSONAL DATA :
Date of birth ; February 27, 1960
Nationality ; Japan
Marital status ; Married (Spouse’s name: Kazumi Nasu)

EDUCATION:
1984 M.D., Okayama University Medical School, Japan
1988 Ph.D., Post-graduate School of Okayama University

TRAINING :
1988-2001 Okayama University Hospital
Kure Kyosai Hospital
Juzen General Hospital

MEMBERSHIPS :
Japanese Urological Association
AUA
EAU
Societe Internationale d’Urologie
Japanese Society of Clinical Oncology
Japanese Society of Endourology and ESWL
Japan Society of Transplantation
Japanese Society of Pediatric Surgeons
Japanese Society for Pediatric Nephrology
Japanese Association for Infectious Disease
Japanese Society for Bacteriology
Japanese Society of Chemotherapy

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MP11-19: Targeted antibiotic prophylaxis by β-lactams based on rectal swab culture is not sufficient to prevent infective complications after transrectal prostate biopsy



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