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Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: fosfomycin trometamol, an attractive alternative

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Abstract

Objective

To compare fosfomycin trometamol (FT) and ciprofloxacin (CIP) for antibiotic prophylaxis in transrectal prostate biopsy (TR-PB).

Patients and methods

Data for 1109 patients (mean age 66.7 ± 8.45) who underwent TR-PB between March to September 2015 in seven Italian urological institutions were retrospectively reviewed, of which 632 received FT (Group 1) and 477 received CIP (Group 2) for prophylaxis. We reviewed all urine culture results obtained after the procedure, all adverse drug reactions (ADRs) related to the drug and all febrile and/or symptomatic urinary tract infections (UTIs) occurring within 1 month after TR-PB. The rate of symptomatic UTIs and the rate of ADRs were considered the main outcome measures.

Results

In the total study population, 72/1109 (6.5 %) patients experienced symptomatic UTIs and among these 11 (0.9 % of total) had urosepsis. Out of 72, 53 (73.6 %) symptomatic UTIs were caused by fluoroquinolone-resistant strains. Out of 632, 10 (1.6 %) patients in Group 1 and 62/477 (12.9 %) patients in Group 2 had symptomatic UTIs (p < 0.001); in particular, 2/632 (0.3 %) patients in Group 1 and 9/477 (1.8 %) patients in Group 2 had urosepsis (p < 0.001). No differences were reported in terms of adverse events (0.6 vs 0.4 %; p = 0.70). A Charlson comorbidity index ≤1 and type of antimicrobial prophylaxis (FT) were found to be associated with a lower probability of symptomatic UTIs in the multivariate model.

Conclusions

Antibiotic prophylaxis with FT for TR-PB had a lower rate of adverse events and a lower rate of symptomatic UTIs as compared with CIP. Fosfomycin trometamol appears as an attractive alternative prophylactic regimen in prostate biopsies.

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Acknowledgments

We are grateful to all members of the microbiological departments in all centers for their assistance and to Professor John Denton for manuscript language revision.

Authors’ contribution

Cai T. and Gallelli L. contributed to study conception and design; Cocci A., Tiscione D., Verze P., Lanciotti M., Vanacore D., Rizzo M., Gacci M., Saleh O., Damiano R., Palmieri A., Malossini G. and Liguori G helped in the acquisition of data; Cai T., Verze P. and Tiscione D. analyzed and interpreted the data; Cai T. and Gallelli L. drafted the manuscript; Wagenlehner F., Naber K., Mirone V. and Bjerklund Johansen T.E.is acknowledged for critical revision and supervisions; and Bjerklund Johansen T.E., Naber K., Bartoletti R., Mirone V., Carini M. and Trombetta C. supervised the intellectual concept.

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Authors and Affiliations

  1. Department of Urology, Santa Chiara Regional Hospital, Largo Medaglie d’Oro, 9, 38123, Trento, Italy

    Tommaso Cai, Daniele Tiscione & Gianni Malossini

  2. Department of Health Science, School of Medicine, University of Catanzaro, Catanzaro, Italy

    Luca Gallelli

  3. Department of Urology, University of Florence, Florence, Italy

    Andrea Cocci, Michele Lanciotti, Davide Vanacore, Mauro Gacci, Omar Saleh & Marco Carini

  4. Department of Urology, University of Naples, Federico II, Naples, Italy

    Paolo Verze, Alessandro Palmieri & Vincenzo Mirone

  5. Department of Urology, University of Trieste, Trieste, Italy

    Michele Rizzo, Giovanni Liguori & Carlo Trombetta

  6. Department of Urology, University of Catanzaro, Catanzaro, Italy

    Damiano Rocco

  7. Department of Urology, University of Pisa, Pisa, Italy

    Riccardo Bartoletti

  8. Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Giessen und Marburg GmbH, Justus-Liebig-Universität Giessen, Giessen, Germany

    Florian M. E. Wagenlehner

  9. Department of Urology, Technical University of Munich, Munich, Germany

    Kurt Naber

  10. Department of Urology, Oslo University Hospital, Oslo, Norway

    Truls E. Bjerklund Johansen

Authors
  1. Tommaso Cai
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  2. Luca Gallelli
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  3. Andrea Cocci
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  4. Daniele Tiscione
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  5. Paolo Verze
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  6. Michele Lanciotti
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  7. Davide Vanacore
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  8. Michele Rizzo
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  9. Mauro Gacci
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  10. Omar Saleh
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  11. Gianni Malossini
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  12. Giovanni Liguori
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  13. Carlo Trombetta
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  14. Damiano Rocco
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  15. Alessandro Palmieri
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  16. Riccardo Bartoletti
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  17. Marco Carini
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  18. Florian M. E. Wagenlehner
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  19. Kurt Naber
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  20. Vincenzo Mirone
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  21. Truls E. Bjerklund Johansen
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Corresponding author

Correspondence to Tommaso Cai.

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Conflict of interest

Tommaso Cai has received grant from Zambon as speaker at scientific meeting; Kurt Naber and Florian Wagenlehner are consultant for and have received research support and grant as speakers at scientific meeting from Zambon.

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Cai, T., Gallelli, L., Cocci, A. et al. Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: fosfomycin trometamol, an attractive alternative. World J Urol 35, 221–228 (2017). https://doi.org/10.1007/s00345-016-1867-6

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  • DOI: https://doi.org/10.1007/s00345-016-1867-6

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