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1、Biopsy Core Number Is the Independent Predictor of Febrile Urinary Tract Infection after Transrectal Ultrasound Guided Prostate Biopsy前列腺切片針數為術後尿道感染旳獨立預測因子前列腺切片針數為術後尿道感染旳獨立預測因子蔡博超1、姜秉均1、蒲永孝1、劉詩彬1、姜宜妮1,2、余宏政1、王碩盟1、張宏江1、黃昭淵11台大醫院 泌尿部;2署立基隆醫院 泌尿科第1页Introduction(1)Infection is a well-known complication
2、of transrectal Infection is a well-known complication of transrectal ultrasound guided prostate biopsy(TRUSP-Bx).ultrasound guided prostate biopsy(TRUSP-Bx).Wide variability in antibiotics prophylaxis has been Wide variability in antibiotics prophylaxis has been reportedreported.The European Associa
3、tion of Urology(EAU)The European Association of Urology(EAU)guidelines on prostate cancer state that“quinolones guidelines on prostate cancer state that“quinolones are the drug of choice in TRUSP-Bx.”are the drug of choice in TRUSP-Bx.”第2页Introduction(2)Sieber et al reported the increase of the comp
4、licated UTI Sieber et al reported the increase of the complicated UTI after TRUSP-Bx was insignificant from sextant biopsy to 10 after TRUSP-Bx was insignificant from sextant biopsy to 10 or 12-core biopsy in a 1000 patients cohortor 12-core biopsy in a 1000 patients cohort.Urology.70:498-500,2023Ur
5、ology.70:498-500,2023Recent literatures have demonstrated an emergence of Recent literatures have demonstrated an emergence of increasing infectious complications and fluoroquinolone increasing infectious complications and fluoroquinolone(FQ)-resistant infections following TRUSP-Bx(FQ)-resistant inf
6、ections following TRUSP-Bx.To determine whether the biopsy core number is To determine whether the biopsy core number is associated with febrile urinary tract infection(fUTI)after associated with febrile urinary tract infection(fUTI)after transrectal ultrasound guided prostate biopsy(TRUSP-Bx)transr
7、ectal ultrasound guided prostate biopsy(TRUSP-Bx).第3页PATIENTS AND METHODS第4页Patients and methods(1)Retrospectively reviewed the electronic medical Retrospectively reviewed the electronic medical records of consecutive males receiving levofloxacin records of consecutive males receiving levofloxacin 5
8、00mg single dose prophylaxis in TRUSP-Bx in 500mg single dose prophylaxis in TRUSP-Bx in National Taiwan University Hospital(NTUH)between National Taiwan University Hospital(NTUH)between January 2023 and December 2023 January 2023 and December 2023 Indications for biopsy:(1)an increased PSA level In
9、dications for biopsy:(1)an increased PSA level and/or(2)abnormal digital rectal examination(DRE).and/or(2)abnormal digital rectal examination(DRE).Exclusion:Exclusion:(1)(1)a pre-existing diagnosis of prostate a pre-existing diagnosis of prostate cancercancer (2)(2)thosethose who did not follow the
10、TRUSP-Bx who did not follow the TRUSP-Bx protocol.protocol.第5页Patients and methods(2)Definition of febrile UTI:Definition of febrile UTI:(1)Body temperature greater than 38(1)Body temperature greater than 38。C in two weeks C in two weeks after biopsy,after biopsy,(2)New-onset lower urinary tract sym
11、ptoms or acute(2)New-onset lower urinary tract symptoms or acute epididymitis,epididymitis,(3)Absence of other sources of infection.(3)Absence of other sources of infection.第6页Patients and methods(3)Transrectal Ultrasound Guided Prostate Biopsy Transrectal Ultrasound Guided Prostate Biopsy Protocol
12、in NTUHProtocol in NTUH Levofloxacin 500mg single dose one hour before biopsy.Levofloxacin 500mg single dose one hour before biopsy.Inpatient setting,sextant biopsy or Inpatient setting,sextant biopsy or 12-core biopsy 12-core biopsy(with/without finger-guided nodular biopsy)with general(with/withou
13、t finger-guided nodular biopsy)with general anesthesia or spinal anesthesiaanesthesia or spinal anesthesia.Outpatient setting,only sextant biopsy in consideration of Outpatient setting,only sextant biopsy in consideration of discomfort related to solely perianal-intrarectal topical discomfort relate
14、d to solely perianal-intrarectal topical lidocaine gel anesthesia.lidocaine gel anesthesia.DRE before the procedure to avoid“trans-fecal”biopsy.DRE before the procedure to avoid“trans-fecal”biopsy.Rectal disinfection with iodine swab.Rectal disinfection with iodine swab.第7页RESULTS第8页ResultA total of
15、 2951 TRUSP-Bx was included between A total of 2951 TRUSP-Bx was included between January 2023 and December 2023.January 2023 and December 2023.The median age was 68 years(ranges 25 to 95).The median age was 68 years(ranges 25 to 95).The median PSA level was 9.7 ng/ml(ranges 0.1 to The median PSA le
16、vel was 9.7 ng/ml(ranges 0.1 to 7500)7500)962(32.6%)males were diagnosed as prostate 962(32.6%)males were diagnosed as prostate cancer after biopsy.cancer after biopsy.92(3.1%)males pathology reports revealed 92(3.1%)males pathology reports revealed histological prostatitishistological prostatitis第9
17、页median test(1.12%)第10页Multivariate studyMultivariate model with logistic regression analysis Multivariate model with logistic regression analysis which included biopsy core number and agewhich included biopsy core number and age.Biopsy core number(Biopsy core number(12core)was still the predictor 1
18、2core)was still the predictor of febrile UTI with of febrile UTI with p p value=0.024.value=0.024.第11页Result35(1.12%)patients experienced febrile UTI after 35(1.12%)patients experienced febrile UTI after TRUSP-Bx.TRUSP-Bx.24(68.6%)had positive urine and/or blood cultures:24(68.6%)had positive urine
19、and/or blood cultures:E.coli in 19(79.2%)-16(84.2%)FQ-resistant.E.coli in 19(79.2%)-16(84.2%)FQ-resistant.Klebsialla pneumoniae in 2(8.3%),Klebsialla pneumoniae in 2(8.3%),Enterobacter cloacae in 1(4.2%),Enterobacter cloacae in 1(4.2%),Serratia marcescens in 1(4.2%),Serratia marcescens in 1(4.2%),En
20、terococcus species in 1(4.2%).Enterococcus species in 1(4.2%).第12页第13页第14页DISCUSSION第15页Discussion(1)2023 EAU guidelines on prostate cancer,the 2023 EAU guidelines on prostate cancer,the cumulative infection rate following TRUSP biopsy cumulative infection rate following TRUSP biopsy was 2.5%was 2.5
21、%.In our studyIn our study,the febrile UTI rates after TRUSP,the febrile UTI rates after TRUSP biopsy range from 0.60 to 1.75%from 2023 to biopsy range from 0.60 to 1.75%from 2023 to 2023.(overall 1.12%)2023.(overall 1.12%)Our results suggest that levofloxacin remains an Our results suggest that lev
22、ofloxacin remains an effective prophylaxis for TRUS-guided prostate effective prophylaxis for TRUS-guided prostate biopsy.biopsy.第16页Discussion(2)This is the largest study for examining the efficacy This is the largest study for examining the efficacy of single dose levofloxacin prophylaxis in TRUSP
23、-of single dose levofloxacin prophylaxis in TRUSP-Bx.(A total of 2951 cases)Bx.(A total of 2951 cases)In our study,12core biopsy was the In our study,12core biopsy was the independent predictor of febrile UTI compared to independent predictor of febrile UTI compared to sextant biopsy.sextant biopsy.
24、Sieber et al reported increase insignificantly in the Sieber et al reported increase insignificantly in the complicated UTI from sextant biopsy to 10 to 12-complicated UTI from sextant biopsy to 10 to 12-core biopsy in a 1000 patients cohortcore biopsy in a 1000 patients cohort.Urology.70:498-500,20
25、23Urology.70:498-500,2023第17页Discussion(3)Retrospective study by reviewing electronic Retrospective study by reviewing electronic medical records in a tertiary referral center.medical records in a tertiary referral center.Failed to evaluate all the potential risk factors of Failed to evaluate all the potential risk factors of infectious complications.infectious complications.第18页CONCLUSION第19页ConclusionBiopsy core numberBiopsy core number serves as the predictor of serves as the predictor of febrile UTI following TRUSP-Bx.febrile UTI following TRUSP-Bx.第20页THANK YOU第21页