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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 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的獨立預測因子. 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 1. 1 台大醫院 泌尿部 ; 2 署立基隆醫院 泌尿科. Introduction(1).

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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 1

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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的獨立預測因子 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1 1台大醫院 泌尿部;2署立基隆醫院 泌尿科

  2. Introduction(1) • Infection is a well-known complication of transrectal ultrasound guided prostate biopsy (TRUSP-Bx). • Wide variability in antibiotics prophylaxis has been reported. • The European Association of Urology (EAU) guidelines on prostate cancer state that “quinolones are the drug of choice in TRUSP-Bx.”

  3. Introduction(2) • Sieber et al reported the increase of the complicated UTI after TRUSP-Bx was insignificant from sextant biopsy to 10 or 12-core biopsy in a 1000 patients cohort. Urology. 70: 498-500, 2007 • Recent literatures have demonstrated an emergence of increasing infectious complications and fluoroquinolone (FQ)-resistant infections following TRUSP-Bx. • To determine whether the biopsy core number is associated with febrile urinary tract infection (fUTI) after transrectal ultrasound guided prostate biopsy (TRUSP-Bx).

  4. PATIENTS AND METHODS

  5. Patients and methods(1) • Retrospectively reviewed the electronic medical records of consecutive males receiving levofloxacin 500mg single dose prophylaxis in TRUSP-Bx in National Taiwan University Hospital (NTUH) between January 2005 and December 2010 • Indications for biopsy: (1) an increased PSA level and/or (2) abnormal digital rectal examination (DRE). • Exclusion:(1)a pre-existing diagnosis of prostate cancer(2)thosewho did not follow the TRUSP-Bx protocol.

  6. Patients and methods(2) • Definition of febrile UTI : • (1) Body temperature greater than 38。C in two weeks after biopsy, • (2) New-onset lower urinary tract symptoms or acute epididymitis, • (3) Absence of other sources of infection.

  7. Patients and methods(3) Transrectal Ultrasound Guided Prostate Biopsy Protocol in NTUH Levofloxacin 500mg single dose one hour before biopsy. Inpatient setting, sextant biopsy or ≧12-core biopsy (with/without finger-guided nodular biopsy) with general anesthesia or spinal anesthesia. Outpatient setting, only sextant biopsy in consideration of discomfort related to solely perianal-intrarectal topical lidocaine gel anesthesia. DRE before the procedure to avoid “trans-fecal” biopsy. Rectal disinfection with iodine swab.

  8. RESULTS

  9. Result • A total of 2951 TRUSP-Bx was included between January 2005 and December 2010. • The median age was 68 years (ranges 25 to 95). • The median PSA level was 9.7 ng/ml (ranges 0.1 to 7500) • 962 (32.6%) males were diagnosed as prostate cancer after biopsy. • 92 (3.1%) males’ pathology reports revealed histological prostatitis

  10. median test (1.12%)

  11. Multivariate study • Multivariate model with logistic regression analysis which included biopsy core number and age. • Biopsy core number (≧12core) was still the predictor of febrile UTI with p value = 0.024.

  12. Result • 35 (1.12%) patients experienced febrile UTI after TRUSP-Bx. • 24 (68.6%) had positive urine and/or blood cultures: • E. coli in 19 (79.2%) - 16 (84.2%) FQ-resistant. • Klebsialla pneumoniae in 2 (8.3%), • Enterobacter cloacae in 1 (4.2%), • Serratia marcescens in 1 (4.2%), • Enterococcus species in 1 (4.2%).

  13. DISCUSSION

  14. Discussion(1) 2010 EAU guidelines on prostate cancer, the cumulative infection rate following TRUSP biopsy was 2.5%. In our study, the febrile UTI rates after TRUSP biopsy range from 0.60 to 1.75 % from 2005 to 2010. (overall 1.12%) Our results suggest that levofloxacin remains an effective prophylaxis for TRUS-guided prostate biopsy.

  15. Discussion(2) This is the largest study for examining the efficacy of single dose levofloxacin prophylaxis in TRUSP-Bx.(A total of 2951 cases) In our study, ≥12core biopsy was the independent predictor of febrile UTI compared to sextant biopsy. Sieber et al reported increase insignificantly in the complicated UTI from sextant biopsy to 10 to 12-core biopsy in a 1000 patients cohort. Urology. 70: 498-500, 2007

  16. Discussion(3) • Retrospective study by reviewing electronic medical records in a tertiary referral center. • Failed to evaluate all the potential risk factors of infectious complications.

  17. CONCLUSION

  18. Conclusion • Biopsy core number serves as the predictor of febrile UTI following TRUSP-Bx.

  19. THANK YOU~

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