Which Antibiotic Prophylaxis is Better to Prevent Infections after Transrectal Prostate Biopsy: Single or Combination?

INTRODUCTION: The aim of this study was to compare the effectiveness of three different prophylaxis methods after transrectal ultrasound-guided prostate biopsy.
METHODS: Patients who underwent a transrectal prostate biopsy were added to the study. Three different prophylactic antibiotic procedures were applied. In the first group, 62 patients received 500 mg ciprofloxacin orally, 87 patients in the second group received 500 mg ciprofloxacin orally plus one dose of 500 mg amikacin intramuscularly, and 91 patients in the third group received 500 mg ciprofloxacin orally plus one dose of 500 mg amikacin plus 500 mg metronidazole intravenously. Additionally, rectal cleansing with povidone-iodine was performed immediately before biopsy for patients in the third group. Demographic data, antibiotic use within the previous 6 months, comorbidite diseases, and presence of a urinary catheter were compared between the groups according to post-biopsy infection rates.
RESULTS: There were 62 patients in the first group, 87 patients in the second group and 91 patients in the third group. Post-biopsy infection was detected in 5 (8.1%) patients in the first group, 2 (2.3%) patients in the second group and 1 (1.1%) patient in the third group. There were statistically significant differences between the groups according to infection rates (p= 0.049). There were no significant differences between the groups according to the presence of diabetes, urethral catheterization and antibiotic use within the previous 6 months, which are risk factors for infection.
DISCUSSION AND CONCLUSION: Combination therapy is a more effective approach to prevent biopsy-related infectious complications than single agent therapy.

Transrektal Prostat Biyopsisi Sonrasý Enfeksiyonlarý Önlemek için Hangi Antibiyotik Profilaksisi Daha Ýyidir: Tek veya Kombinasyon?

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý ultrason eþliðinde yapýlan transrektal prostat biyopsisinde kullanýlan üç farklý antibiyotik profilaksisinin etkinliðini karþýlaþtýrmaktýr
YÖNTEM ve GEREÇLER: Ultrason eþliðinde transrektal prostat biyopsisi yapýlan hastalar çalýþmaya alýndý. Üç farklý antibiyotik profilaksisi uygulandý. Birinci gruptaki hastalar aðýzdan 500 mg siprofloksasin aldý. Ýkinci gruptaki hastalar aðýzdan 500 mg siprofloksasin ile birlikte tek doz 500 mg amikasini kas içi uygulama þeklinde aldýlar. Üçüncü gruptaki hastalar aðýzdan 500 mg siprofloksasin, tek doz 500 mg amikasin ve 500 mg metronidazolü damar içi uygulama yoluyla aldý. Ek olarak 3. gruptaki hastalara biyopsi iþleminden hemen önce povidon – iyot ile rektal temizlik yapýldý. Biyopsi sonrasý enfeksiyon görülme oranlarý, gruplarýn demografik özelliklerine, son 6 ay içinde antibiyotik kullanýmýna, ek hastalýklarýn varlýðýna ve sonda kulanýmýna göre karþýlaþtýrýldý.
BULGULAR: Birinci grupta 62, ikinci grupta 87 ve üçüncü grupta 91 hasta vardý. Biyopsi sonrasý enfeksiyon 1. grupta 5 (%8,1) hastada, ikinci grupta 2 (%2,3) hastada ve 3. grupta 1 (%1,1) hastada görüldü. Enfeksiyon oranlarý açýsýndan gruplar arasýnda istatistiksel olarak anlamlý farklýlýk vardý (p: 0,049). Enfeksiyon için risk faktörleri olabilecek diabet varlýðý, sonda kullanýmý ve son 6 ay içinde antibiyotik kullanýmý açýsýndan gruplar arasý farklýlýk saptanmadý.
TARTIÞMA ve SONUÇ: Transrektal prostat biyopsisiyle iliþkili enfeksiyonlarý önlemede kombine antibiyotik profilaksisi tek ajan antibiyotik profilaksisine göre daha etkilidir.