Short summary

This is a quality control study initiated after we have changed the standard prophylaxis before transrectal ultrasound guided prostate biopsies.

Rationale

With the introduction and subsequent wide spread use of prostate specific antigen testing in men, we have also seen an increase in the number of patients having transrectal prostate biopsies (TRUSp) taken. In 2017 alone 7865 patients underwent the procedure in Denmark 1. Being transrectal the procedure has an inherent high risk of causing infections, and antibiotic prophylaxis should always be administered beforehand Both national and international guidelines recommend the use of flourquinolones 2. However, quinolone resistance has become an increasing problem and has made it difficult to meet the requirements from the Danish Urological Cancer Group of a maximum infection rate after TRUSp of 5%. Recently, we performed a retrospective investigation of our TRUSp patients during 2014, 2015 and 2016. For the entire period the antibiotic prophylaxis consisted of 500 mg Ciprofloxacine orally two hours before TRUSp and six hours after the procedure. We found that majority of resubmissions after TRUSp was caused by Ciprofloxacine resistant E-Coli and that our one-week infection rate was 5,1% (Unpublished). This is in line with previous studied which also concluded that the problems with infections after TRUSp were caused by quinolone resistance 3-5. In the study by Antsupova et al. the authors describe a change of antibiotic prophylaxis to Amoxicillin/Clavulanic acid in combination with Mecillinam after which they registered a decrease in quinolone resistance and a decrease in infections after TRUSp. Amoxicillin/Clavulanic acid in combination with Mecillinam have a synergistic effect covering a broad spectrum of enteropathogens and Staphylococcus 4. The same study describes a prophylaxis regime where a dose of antibiotics is given the day before and three times a day for two days after the procedure. After thorough consideration and discussions with the Department of Microbiology we decided to change prophylaxis to Amoxicillin/Clavulanic acid in combination with Mecillinam.     

The aims of this study are to document the prevalence and causes of infections after TRUSp with the introduction of Amoxicillin/Clavulanic acid in combination with Mecillinam as prophylaxis to TRUSp. 

Description of the cohort

The study will include all patient who undergo TRUSp at the Department of Urology, SVS Esbjerg from 1/1-19 to 1/1-20

Data and biological material

Along with information on how many biopsies were taken, demographic information on age, comorbidities, risk of harboring multi resistant Staphylococcus Aureus, previous TRUSp, previous use of antibiotics, and histological result will be collected at baseline. When patients are submitted to a hospital with infections within 30 days after TRUSp, information on blood and urine cultures will be collected. All data will be stored in a password protected Redcap database provided by OPEN. 

Collaborating researchers and departments

Department of Urology, Esbjerg Hospital

• PhD student Anders Frey, MD
• Consultant Søren Madsen
• Christian Rostgaard Marker, MD