International Journal of Urology | 2019
Editorial Comment to Selective culture of Escherichia coli to prevent infective complications of transrectal ultrasound‐guided prostate biopsy: Clinical efficacy and analysis of characteristics of quinolone‐resistant Escherichia coli
Abstract
The clinical study by Hiyama et al. was a well-designed prospective study that aimed to evaluate the efficacy of targeted antimicrobial prophylaxis based on selective culture of Escherichia coli before transrectal ultrasound-guided (TRUS) prostate biopsy. Just three patients out of 397 developed febrile complications in this study. The frequency of infective complications was 0.77%. The authors concluded that this low incident rate of febrile complications showed the clinical efficacy of the antimicrobial selection using rectal swab culture. TRUS prostate biopsy is a commonly carried out procedure used for the detection of prostate cancer. Although TRUS prostate biopsy is generally considered a safe procedure, the overall incidence of infective complications can be as high as 6.3%, with readmission rate ranging from 0.8 to 3%. Antimicrobial prophylaxis significantly decreases infective complications, and fluoroquinolone (FQ) is the antibiotic class most widely used as prophylaxis for TRUS prostate biopsy. Facing the significant increase of FQ-resistant strains from clinical isolates, many urologists doubt the efficacy of conventional FQ-based prophylactic regimens for TRUS prostate biopsy. Culture-based targeted antimicrobial prophylaxis for TRUS prostate biopsy has been recommended to prevent infective complications caused by FQ-resistant strains. Recently, Jiang et al. reported in their large retrospective study that empirical prophylaxis was statistically superior to single targeted prophylaxis, and the efficacy of the antimicrobial selection using rectal swab culture remained obscure. Further analysis, such as larger randomized controlled trials, will be necessary. Yoshitsugu Nasu M.D., Ph.D. Department of Urology, Okayama Rosai Hospital, Okayama, Japan [email protected]