De invloed van perineale bacteriële resistentie voor ciprofloxacine op de incidentie van infecties na transrectale echogeleide prostaatbiopsie onder profylactisch ciprofloxacine

Abstract

Introduction: Transrectal ultrasound guided prostate biopsy (TRUSPB) is an essential procedure in the diagnosis of prostate cancer. Unfortunately, this procedure has risks, including infection. For this reason, a prophylaxis is recommended, such as ciprofloxacin. However, there is an increasing trend regarding ciprofloxacin resistance of E. coli. Recent literature suggests that this resistance is the most likely cause of infection after TRUSPB. The aim of this study is to demonstrate whether the occurrence of an infection after TRUSPB under prophylactic ciprofloxacin is due to the bacterial resistance to this antibiotic and that this resistance can be demonstrated by a perineum swab. Material and Method: From 1 October 2012 to 31 December 2012 all men in Ziekenhuisgroep Twente en Medisch Spectrum Twente, who underwent prostate biopsy and granted informed consent, were included. Exclusion criteria were immunological diseases and status after radical prostatectomy. A perineum swab was obtained prior to TRUSPB with ciprofloxacin as prophylaxis. This culture was assessed on gram-negative bacteria (GNB) and ciprofloxacin resistance. If a culture showed no GNB, ciprofloxacin resistance could not be tested and therefore these cultures could not be included to answer the research question. At least 31 days after the TRUSPB and the perineum swab, the electronic medical records of the enrolled patients were evaluated to inventory subjective and objective infectious symptoms. Hereafter, comparison was done on the incidence of infection between patients with ciprofloxacin-resistant GNB on the perineum and the patients without ciprofloxacin resistant GNB on the perineum. Results: Of the 144 executed swabs, 25 (17.4%) had control cultures positive for GNB. Only these 25 cases were included for the research question. In previous calculations of the sample size this failure was not calculated. Of the 25 patients enrolled, five (20%) ciprofloxacin-resistant gram-negative rods. In total, there were two infectious complications in the 25 patients. In both groups, there was one case. Both groups had a casus of prostatitis, which was not confirmed by the urologist. There was no significant difference between the two groups and the occurrence of infection (p = 0.367). In addition, the age found in the group without ciprofloxacin-resistant bacteria was average 68.5 years, in contrast to the group with ciprofloxacin-resistant bacteria with a mean age of 59.4 years (p = 0.024). Univariate logistic regression showed an odds ratio of 0.818 age in the presence of ciprofloxacin resistant GNB on the perineum (p = 0.036). Conclusion: It could not be proven that bacterial resistance to ciprofloxacin at the perineum had any influence on the development of infections after TRUSPB. Also a perineum swab showed to be no good measure instrument in this study. Prospective multicenter study with a larger sample size and another measure instrument is advised.