Objectives: It was the aim of this study to evaluate the efficacy of single-dose fosfomycin prophylaxis as an alternative to fluoroquinolone-based prophylaxis in transrectal ultrasound-guided biopsy of the prostate (TRUSBP). Methods: We evaluated the records of 620 patients who had undergone TRUSBP from January 2010 to July 2011. Patients received a single dose of 3 g oral fosfomycin or a single dose of 500 mg oral levofloxacin or 500 mg oral ciprofloxacin twice daily administered for 5 days starting 1 day before the prophylaxis procedure. We reviewed all febrile and afebrile urinary tract infections (UTIs) within 1 month after TRUSBP. Results: Of the 620 patients, 19 (3.0%) developed febrile UTI and 51 (8.2%) developed afebrile UTI after biopsy. Of the 19 patients with febrile UTI, 1/19 (5.2%) received fosfomycin, 4/19 (21%) received levofloxacin and 14/19 (73.6%) received ciprofloxacin for prophylaxis. Of the 51 patients with afebrile UTI, 4/51 (7.8%) received fosfomycin, 8/51 (15.6%) received levofloxacin and 39/51 (76.4%) received ciprofloxacin for prophylaxis. There were a total of 10 fluoroquinolone-resistant infections, and all of them occurred after the ciprofloxacin or levofloxacin prophylaxis and none after fosfomycin prophylaxis. Conclusions: The ease of use of fosfomycin, reducing the rate of fluoroquinolone-resistant infections and hospitalizations shows that it would be an alternative and effective drug for antimicrobial prophylaxis in TRUSBP.

Keywords:
Fluoroquinolone, Fosfomycin, Prophylaxis, Prostate biopsy, Transrectal ultrasonography, Urinary tract infection
1.
Djavan B, Waldert M, Zlotta A, Dobronski P, Seitz C, Remzi M, et al: Safety and morbidity of first and repeat transrectal ultrasound-guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol 2001;166:856–860.
2.
Aus G, Ahlgren G, Bergdahl S, Hugosson J: Infection after transrectal core biopsies of the prostate – risk factors and antibiotic prophylaxis. Br J Urol 1996;77:851–855.
3.
Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH, et al: Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 2010;183:963–969.
4.
Kapoor DA, Klimberg IW, Malek GH, Wegenke JD, Cox CE, Patterson AL, et al: Single-dose ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy. Urology 1998;52:552–558.
5.
Aron M, Rajeev TP, Gupta NP: Antibiotic prophylaxis for transrectal needle biopsy of the prostate: a randomized controlled study. BJU Int 2000;85:682–685.
6.
European Association of Urology: Prostate cancer; in European Association of Urology: The European Association of Urology Guidelines. Arnhem, 2010.
7.
Best Practice Policy Statement on Urologic Surgery Antimicrobial Prophylaxis. http://www.auanet.org/content/media/antimicroprop08.pdf (accessed May 12, 2012).
8.
Fink KG, Schmid HP, Paras L, Schmeller NT: Prostate biopsy in Central Europe: results of a survey of indication, patient preparation and biopsy technique. Urol Int 2007;79:60–66.
9.
Feliciano J, Teper E, Ferrandino M, Macchia RJ, Blank W, Grunberger I, et al: The incidence of fluoroquinolone resistant infections after prostate biopsy – are fluoroquinolones still effective prophylaxis? J Urol 2008;179:952–955.
10.
Shigehara K, Miyagi T, Nakashima T, Shimamura M: Acute bacterial prostatitis after transrectal prostate needle biopsy: clinical analysis. J Infect Chemother 2008;14:40–43.
11.
Falagas ME, Kastoris AC, Kapaskelis AM, Karageorgopoulos DE: Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum β-lactamase-producing, Enterobacteriaceae infections: a systematic review. Lancet Infect Dis 2010;10:43–50.
12.
Ishizaka K, Kobayashi S, Machida T, Yoshida K: Randomized prospective comparison of fosfomycin and cefotiam for prevention of postoperative infection following urological surgery. J Infect Chemother 2007;13:324–331.
13.
Simsir A, Kismali E, Mammadov R, Gunaydin G, Cal C: Is it possible to predict sepsis, the most serious complication in prostate biopsy? Urol Int 2010;84:395–399.
14.
Whittam BM, Thomasch JR, Makari JH, Tanaka ST, Thomas JC, Pope JC 4th, et al: Febrile urinary tract infection after ureteroneocystostomy: a contemporary assessment at a single institution. J Urol 2010;183:688–692.
15.
Horan TC, Gaynes RP: Surveillance of nosocomial infections; in Mayhall CG (ed): Hospital Epidemiology and Infection Control, ed 3. Philadelphia, Lippincott, Williams and Wilkins, 2004, pp 1659–1702.
16.
Zaytoun OM, Vargo EH, Rajan R, Berglund R, Gordon S, Jones JS: Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment. Urology 2011;77:1035–1042.
17.
Shandera KC, Thibault GP, Deshon GE Jr: Variability in patient preparation for prostate biopsy among American urologists. Urology 1998;52:644–646.
18.
Durham LK, Ge M, Cuccia AJ, Quinn JP: Quinn modeling antibiotic resistance to project future rates: quinolone resistance in Escherichia coli. Eur J Clin Microbiol Infect Dis 2010;29:353–356.
19.
Akduman B, Akduman D, Tokgöz H, Erol B, Türker T, Ayoğlu F, et al: Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms. Urology 2011;78:250–256.
20.
Lange D, Zappavigna C, Hamidizadeh R, Goldenberg SL, Paterson RF, Chew BH: Bacterial sepsis after prostate biopsy – a new perspective. Urology 2009;74:1200–1205.
21.
Ozden E, Bostanci Y, Yakupoglu KY, Akdeniz E, Yilmaz AF, Tulek N, et al: Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy. Urology 2009;74:119–123.
22.
Hyle EP, Lipworth AD, Zaoutis TE, Nachamkin I, Bilker WB, Lautenbach E: Impact of inadequate initial antimicrobial therapy on mortality in infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae: variability by site of infection. Arch Intern Med 2005;165:1375–1380.
23.
Raajimakers R, Kirkels WJ, Roobol MJ, Wildhagen MF, Schrder FH: Complication rates and risks factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology 2002;60:826–830.
24.
Bulitta JB, Kinzig M, Naber CK, Wagenlehner FM, Sauber C, Landersdorfer CB, et al: Population pharmacokinetics and penetration into prostatic, seminal, and vaginal fluid for ciprofloxacin, levofloxacin, and their combination. Chemotherapy 2011;57:402–416.
25.
Raz R: Fosfomycin: an old-new antibiotic. Clin Microbiol Infect 2012;18:4–7.
26.
Selvaggi FP, Battaglia M, Grossi FS, Disabato G, Cormio L: Oral prophylaxis with fosfomycin trometamol in transurethral prostatectomy and urological maneuvers: literature review and personal experience. Infection 1992;20(suppl 4):321–324.
27.
Arslan H, Azap OK, Ergönül O, Timurkaynak F: Urinary Tract Infection Study Group. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother 2005;56:914–918.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.