Ivan Colon

The Incidence of Fluoroquinolone Resistant Infections After Prostate Biopsy—Are Fluoroquinolones Still Effective Prophylaxis?

PURPOSEnFluoroquinolones have been shown to decrease infective complications after prostate biopsy. However, fluoroquinolone resistance is emerging. We quantified contemporary rates of infective complications and the incidence of fluoroquinolone resistant infections after prostate biopsy under fluoroquinolone prophylaxis.nnnMATERIALS AND METHODSnWe retrospectively evaluated the records of 1,273 patients who underwent prostate biopsy at New York Harbor Veterans Affairs Hospital from January 2004 to December 2006. Patients received levofloxacin or gatifloxacin. Using the Veterans Affairs computerized patient record system we reviewed all patient visits within 1 month after prostate biopsy. Visits were queried for infective symptoms. Positive cultures were evaluated for resistance patterns. The annual and overall incidence of infective complications and fluoroquinolone resistant infections was calculated.nnnRESULTSnOf 1,273 patients 31 (2.4%) presented with infective symptoms after biopsy. The overall incidence of fluoroquinolone resistant infections was 1.2% (15 cases). When stratified by year, there were statistically significant increases in the incidence of infective complications and fluoroquinolone resistance from 2004 to 2006. Of the positive cultures those from 89% of patients yielded Escherichia coli and 90% were fluoroquinolone resistant. Fluoroquinolone resistant E. coli were also resistant to gentamicin in 22% of cases, trimethoprim/sulfamethoxazole in 44%, piperacillin in 72% and ampicillin in 94%. However, 100% sensitivity was demonstrated for amikacin, ceftazidime and ceftriaxone.nnnCONCLUSIONSnFluoroquinolones are still effective as antibiotic prophylaxis for prostate biopsies but there is an increase in infective complications and fluoroquinolone resistance. When patients present with post-prostate biopsy infective symptoms, almost 50% are associated with fluoroquinolone resistant pathogens. Empirical treatment with ceftriaxone, ceftazidime or amikacin should be initiated until culture specific therapy can be implemented.

MP27-13 RANDOMIZED STUDY OF GREENLIGHT XPS LASER VS BIPOLAR VAPORIZATION ELECTRODE (BIVAP) SALINE VAPORIZATION OF THE PROSTATE IN MEN WITH SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA (BPH)

INTRODUCTION AND OBJECTIVES: As per Goliath trial, Greenlight laser (XPS) Photoselective Vaporization of the prostate (GL.PVP) is non-inferior to TURP in reduction of LUTs secondary to BPH with all advantages of laser. Plasma Kinetic vaporization of the prostate (PKVP) is a potential contender to the evolving Greenlight PVP. In this study, non-inferiority of PKVP compared to GL.PVP, in reduction of LUTS secondary to BPH, was tested in a randomized trial. METHODS: Between November 2014 and October 2015, 120 patients with complicated BPH (size 30-80 cc) were randomized to GL.PVP and PKVP.Patients were assessed postoperatively using I-PSS, QOL, Qmax and PVR (at 1, 4, and 12 months), IIEF-15 and PSA (at 4 and 12 months). Non-inferiority of I-PSS at 1 year was evaluated using a 1-sided test at 5% level of significance. The statistical significance of other comparators was assessed at the (2-sided) 5% level. RESULTS: At time of analysis 58 GL.PVP and 61 PKVP procedures were included. Patients’ demographics, prostate size, indications of intervention and perioperative parameters were comparable between both groups apart from more perioperative irrigant fluid use in GL.PVP (P 1⁄40.014). More postoperative dysuria was reported after PKVP, dysuria visual analogue scale 4(0-10) vs. 6(0-10), P1⁄40.005 in GL.PVP and PKVP respectively. Urinary outcome measures revealed significant comparable improvement in both groups at different follow up points either in the net value or in the percentage improvement from baseline measure. At 1 year, median IPSS was 6 (1:25) vs 5 (1:18) P1⁄40.7, median QoL was 1 (0:5) vs 1 (1:5) P1⁄40.84, mean Q max was 22 9.4 vs 20 8.5 ml/sec P1⁄40.42, median PVR was 20 (0:97) vs 25 (0:109) ml P1⁄40.14, in GL.PVP and PKVP respectively. Median postoperative change in PSA was 63.5% (-54:95) following GL.PVP vs 31.6% (-66:30) after PKVP, P1⁄40.027. Both groups showed comparable perioperative and late postoperative complication and re-intervention rate during the first year. Among sexually active men (25%), there was significant reduction of IIEF-15 score following PKVP in comparison to GL.PVP CONCLUSIONS: PKVP is a safe and effective modality in treating patients with LUTS secondary to small to moderate sized BPH. In terms of symptoms control, it was not inferior to GL.PVP at 1 year. Long-term durability of the outcome is critical considering the difference in postoperative PSA reduction. Impact on the sexual function should be considered for further evaluation in a larger cohort of sexually active men.