Podium Session

Poster, Podium & Video Sessions

PD11-07: Chemoprophylaxis during Transrectal Prostate Needle Biopsy: Interim analysis of randomized clinical trial(NCT02423759)

Friday, May 12
2:00 PM - 2:10 PM
Location: BCEC: Room 251

Presentation Authors: Ahmed M. Atwa*, Ahmed M. Elshal, Ahmed R. El-Nahas, Mohamed A. El-Ghar, Hashim Farg, Ali Elsorougy, Essam Elsawy, Asaad Gaber, Yasser Farag, Abdelwahab Hashem, Hossam Nabeeh, Ahmed Mosbah, Mansoura, Egypt

Introduction: Post Transrectal biopsy infectious complications (PTBICs) are increasing due to rising fluoroquinolone resistance (FQ-R). Targeted prophylaxis based on prebiopsy rectal swabs has reduced PTBICs. However, rectal swab prior to every biopsy would create a burden for laboratories and extra costs. A randomized trial testing 3 chemoprophylaxis

Methods: Men presented for prostate biopsy were randomized to receive ciprofloxacin 500mg B.I.D for 3days from the night of biopsy(group A), augmented prophylaxis using ciprofloxacin and single prebiopsy shot of 160mg gentamycin IM(group B) and rectal swab culture based prophylaxis(group C).
Primary end point is occurrence of postprocedure sepsis[ge]2 of SIRS (systemic inflammatory response syndrome) criteria. Inflammatory markers were used for postprocedure screening; CRP(C reactive protein), ESR(Erythrocyte sedimentation rate) and TLC(total leucocyte count). Secondary endpoint is occurrence of FQ-R in the screened men. Men were assessed 2 weeks prior to biopsy, at time of biopsy and 2 weeks after.

Results: Since November 2015, 258patients were randomized 89, 94 and 80 patients in groups A, B and C respectively. Baseline data was comparable among the 3 groups including prebiopsy urine culture with significant growth in 8 (8.9%), 8 (8.5%) and 10 (12%) in groups A, B and C respectively (P 0.6) and were treated before biopsy.
Postprocedure fever occurred in 19 (21.3%), 9 (9.5%) and 8 (10%) in groups A, B and C respectively (P 0.03). Sepsis was reported in 5 (5.6%), 5 (5.3%) and 4 (5%) in groups A, B and C respectively (P 0.9) and 2 (2.2%) patients in group A required hospitalization. Figure 1 shows that the degree of change in TLC and ESR-1stH group was significantly more in group A than other groups (P 0.04 and 0.02 respectively). Urine culture 2 weeks after biopsy showed significant growth in 23 (25.8%), 5 (5.3%) and 11 (13.7%) in groups A, B and C respectively (P 0.002)
Significant bacterial growth was noted in 62 (77.5%) out of 80 rectal swabs, FQ-R was reported in 55/62 (88.2%)

Conclusions: With increasing FQ-R, ciprofloxacin alone is not an optimal prophylactic approach. Augmented prophylaxis with single dose gentamycin is an effective approach. Targeted prophylaxis might be used when gentamycin is contraindicated.

Source Of Funding: none

Ahmed M. Atwa, For USA or Canada, please select


28 years old
Driver's Licence

Date of Birth: 08/07/1988
Status: Married with 2 children
Languages: Arabic, English and French
Hobbies: Reading, walking and helping others

Chief urology resident
Urology resident since April 2013

Responsibilities completed
Radical cystectomy and urinary diversion
Ileal w neobladder (Mansoura pouch)
Ileal conduit
Augmentation ileocystoplasty
Simple nephrectomy
Radical nephrectomy
open prostatectomy
Direct Visual Internal Urethrotomy
Transurethral Rsection of Bladder Tumors
Transurethral Resection of the Prostate
Transurethral Incision of the Prostate
Visual Cystolitholapaxy
Percutaneous Nephrolithotomy (straightforward cases)
Endoscopic meatotomy
High inguinal orchiectomy
Repair of penile fracture
Subcapsular orchiectomy
Total orchiectomy
Posterior urethral valve ablation
Ureterovesical reimplantation
TRUS guided biopsy
US and fluoroscopic-guided Percutaneous nephrostomy tube fixation
US-guided Percutaneous tube drain fixation
Renal biopsy
Renal allograft biopsy
Clinical research
Presentation skills

Company website

Faculty of Medicine
Mansoura University September 2006 to March 2012
Details and Extracurriculars
Excellence Degree with honor


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PD11-07: Chemoprophylaxis during Transrectal Prostate Needle Biopsy: Interim analysis of randomized clinical trial(NCT02423759)

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