经直肠超声引导的前列腺活检(TRPB)已成为诊断前列腺癌的标准护理,但与感染性并发症的高发生率相关。
旨在就磷霉素氨丁三醇是否能充分预防TRPB达成专家共识,并讨论其在经会阴前列腺活检(TPPB)中的预防作用。
国际多学科专家组远程召开会议,讨论如何在各种临床环境和患者情况下最好地使用磷霉素。提出了与前列腺活检和磷霉素作用相关的六项声明,基于文献检索和相关临床经验。
六项声明达成共识。专家组一致认为磷霉素是TRPB抗菌预防的首选候选药物。磷霉素也可能满足TPPB经验性预防的要求,尽管需要进一步的临床研究来确认或反驳其在这种情况下的效用。由于制药公司的赞助,存在偏见的风险。
在TRPB中必须进行抗菌预防,和磷霉素氨丁三醇是一个合适的候选由于低耐药率,良好的安全性,足够的前列腺浓度,并证明了在降低TRPB后感染并发症风险方面的有效性。
接受经直肠超声引导下前列腺穿刺活检(TRPB)的患者感染并发症的风险很高,和抗菌预防是强制性的。然而,增加抗菌素耐药性,以及氟喹诺酮类药物的安全问题,限制了抗菌药物选择的数量。磷霉素氨丁三醇满足预防TRPB中优选的抗微生物剂的要求。
Transrectal ultrasound-guided prostate biopsy (TRPB) has been a standard of care for diagnosing prostate cancer but is associated with a high incidence of infectious complications.
To achieve an expert
consensus on whether fosfomycin trometamol provides adequate prophylaxis in TRPB and discuss its role as prophylaxis in transperineal prostate biopsy (TPPB).
An international multidisciplinary group of experts convened remotely to discuss how to best use fosfomycin in various clinical settings and patient situations. Six statements related to prostate biopsy and the role of fosfomycin were developed, based on literature searches and relevant clinical experience.
Consensus was reached for all six statements. The group of experts was unanimous regarding fosfomycin as a preferred candidate for antimicrobial prophylaxis in TRPB. Fosfomycin potentially also meets the requirements for empiric prophylaxis in TPPB, although further clinical studies are needed to confirm or refute its utility in this setting. There is a risk of bias due to sponsorship by a pharmaceutical company.
Antimicrobial prophylaxis is mandatory in TRPB, and fosfomycin trometamol is an appropriate candidate due to low rates of resistance, a good safety profile, sufficient prostate concentrations, and demonstrated efficacy in reducing the risk of infectious complications following TRPB.
Patients undergoing transrectal ultrasound-guided prostate biopsy (TRPB) have a high risk of infectious complications, and antimicrobial prophylaxis is mandatory. However, increasing antimicrobial resistance, as well as safety concerns with fluoroquinolones, has restricted the number of antimicrobial options. Fosfomycin trometamol meets the requirements for a preferred antimicrobial in the prophylaxis of TRPB.