Antibiotic prophylaxis in patients who had undergone to prostate biopsy in between the EMA warning era: effects of fluoroquinolones in diabetic and non-diabetic patients. Results of an observational cohort study - Scorecard - MDSpire
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Antibiotic prophylaxis in patients who had undergone to prostate biopsy in between the EMA warning era: effects of fluoroquinolones in diabetic and non-diabetic patients. Results of an observational cohort study
Clinical Scorecard: Impact of Fluoroquinolone Antibiotic Prophylaxis on Urinary Tract Infection Rates in Diabetic and Non-Diabetic Patients Following Prostate Biopsy During the EMA Warning Period: Findings from an Observational Cohort Study
At a Glance
Category
Detail
Condition
Urinary tract infections (UTIs) following trans-rectal ultrasound-guided prostate biopsy (TRUSPB)
Key Mechanisms
Increased UTI risk due to diabetes mellitus (DM), antibiotic resistance, and biopsy-related factors; EMA warning restricting fluoroquinolone use
Target Population
Patients undergoing TRUSPB, with a focus on diabetic patients
Care Setting
Urology outpatient and inpatient settings performing prostate biopsy
Key Highlights
Patients with diabetes mellitus have higher rates of UTIs and infective complications after TRUSPB.
EMA warning restricted fluoroquinolone use for prophylaxis, leading to varied antibiotic regimens including cefixime, trimethoprim–sulphametoxazole, and augmented prophylaxis.
Multivariable analysis identified diabetes and antibiotic prophylaxis regimen as significant factors influencing post-biopsy infective complications.
Guideline-Based Recommendations
Diagnosis
Perform urine culture before biopsy to exclude existing urinary tract infections.
Use abdominal ultrasound independently from trans-rectal ultrasound investigations.
Management
Administer antibiotic prophylaxis doses the night before, 2 hours to 30 minutes before, and 24 and 48 hours after biopsy per EAU guidelines.
Adapt antibiotic dosages based on creatinine clearance and estimated glomerular filtration rate (eGFR).
Consider augmented prophylaxis (e.g., ceftriaxone/fosfomycin) especially after EMA fluoroquinolone restrictions.
Monitoring & Follow-up
Monitor for short- and long-term complications post-biopsy including unplanned visits or hospital readmissions.
Conduct susceptibility testing for patients developing infective complications to guide antibiotic choice.
Risks
Increased risk of infective complications in patients with diabetes mellitus and higher body mass index.
Higher incidence of UTIs and febrile infections following TRUSPB compared to trans-perineal biopsy.
Rising antibiotic resistance, particularly to fluoroquinolones, impacting prophylaxis effectiveness.
Patient & Prescribing Data
143 diabetic patients selected from a cohort of 1150 patients undergoing TRUSPB between 2017 and 2019.
Various antibiotic prophylaxis regimens were used including fluoroquinolones and alternatives; resistance patterns influenced regimen choice during EMA warning period.
Clinical Best Practices
Exclude patients with allergies to antibiotics or other relevant substances prior to prophylaxis.
Adjust antibiotic dosing according to renal function parameters.
Use targeted or augmented antibiotic prophylaxis in settings with high fluoroquinolone resistance.
Collect comprehensive clinical data including comorbidities and co-medications to assess infection risk.
Employ multivariable logistic regression to identify patient-specific risk factors for infective complications.
