PDF(Pubmed)
Abstract：
Introduction A transperineal ultrasound-guided prostate biopsy (TPB) under local anaesthetics (LA) after a prostate MRI scan is the gold standard for performing a prostate biopsy in patients with suspected prostate cancer. It has superseded transrectal ultrasound-guided prostate biopsy (TRUSB). Historically, TRUSB by definition was performed in a contaminated environment and was routinely covered with antibiotics to reduce the risks of infection. Despite this, the rate of post-biopsy urosepsis has been documented to be as high as 5% in some series. In the transition from TRUSB to the establishment of a TPB under LA service in our unit, we continued to use a single dose of oral antibiotics for all patients attending for biopsy. The aim of this study is to establish whether the use of single-dose antibiotics has any effect on morbidity rates post-TPB. Methods A retrospective analysis of complications was carried out on 326 consecutive patients, who underwent TPB over a six-month period. One cohort of patients were biopsied with no antibiotic cover (n=149, 45.7%) as compared to another cohort who were given a single dose of oral antibiotics (n=177, 54.3%). Those patients in the group receiving antibiotics received either a single dose of co-amoxiclav or a single dose of ciprofloxacin. Patients with indwelling urethral catheters or with a urinary tract infection (UTI) were excluded from the analyses. All patients were followed- up after a multidisciplinary team meeting discussion (MDT) with either a telephone or a face-to-face consultation. Results A total of 324 (99.4%) patients did not report post-procedural complications. Two patients from the antibiotic group presented with infectious complications (1.1%); one patient was admitted with a prostate abscess and required drainage under general anaesthesia, and another was admitted with urosepsis requiring intravenous antibiotics. In the group who did not receive antibiotics, there were no complications reported, which was not significantly different compared to the antibiotic group (p=0.50). Conclusion Our results demonstrate that the routine use of single-dose antibiotics with TPB does not affect morbidity rates. On the basis of this investigation, we have now stopped using routine antibiotic cover for patients undergoing an LA TPB.
摘要：
简介前列腺MRI扫描后在局部麻醉剂（LA）下进行经会阴超声引导的前列腺活检（TPB）是对疑似前列腺癌患者进行前列腺活检的金标准。它取代了经直肠超声引导的前列腺活检（TRUSB）。历史上,根据定义，TRUSB是在受污染的环境中进行的，并且通常用抗生素覆盖以降低感染风险。尽管如此,在某些系列中,活检后尿脓毒血症的发生率高达5%.在从TRUSB过渡到在我们单位的LA服务下建立TPB的过程中，我们继续对所有接受活检的患者使用单剂量口服抗生素.这项研究的目的是确定单剂量抗生素的使用是否对TPB后的发病率有任何影响。方法对326例患者的并发症进行回顾性分析,他在六个月内接受了城规会。与另一个给予单剂量口服抗生素的队列(n=177,54.3%)相比,一个队列的患者进行了无抗生素覆盖的活检(n=149,45.7%)。接受抗生素组的那些患者接受单剂量的联合阿莫昔卡夫或单剂量的环丙沙星。留置尿道导管或尿路感染（UTI）的患者被排除在分析之外。在通过电话或面对面咨询进行多学科小组会议讨论（MDT）后，所有患者均被随访。结果：324例（99.4%）患者未报告术后并发症。抗生素组的两名患者出现感染并发症(1.1%)；一名患者因前列腺脓肿入院，需要在全身麻醉下引流，另外一名患者因需要静脉注射抗生素而出现尿脓毒血症。在没有接受抗生素治疗的人群中，没有并发症的报道，与抗生素组相比没有显着差异（p=0.50）。结论我们的结果表明，单剂量抗生素与TPB的常规使用不会影响发病率。在这次调查的基础上,我们现在已经停止对接受LATPB的患者使用常规抗生素覆盖.
