Adding Gentamycin to Fluoroquinolone-based Antimicrobial Prophylaxis Reduces Transrectal Ultrasound-Guided Prostate Biopsy-related Infection Rate
Chi-Hang Hsiao1, Tzuo-Yi Hsieh1, Yu-Lin Kao1,2, Shao-Chuan Wang1 , Wen-Jung Chen1,
1Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
2School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
Purpose: Transrectal ultrasound(TRUS)-guided prostate biopsy is the standard method for the diagnosis of prostate cancer. Fluoroquinolone-based prophylaxis before a TRUS biopsy of the prostate is the most common regimen worldwide. In this retrospective study, we evaluated the efficacy and cost-effectiveness of adding gentamicin to a fluoroquinolone-based prophylaxis regimen on the patient who received TURS biopsy of prostate.
Materials and Methods: In total, our study included 263 patients across two groups in this study. Group 1 consisted of 129 patients who received one oral dose of 500 mg levofloxacin daily two days before the biopsy, on the day of the biopsy, and for two days after the biopsy. Group 2 consisted of 134 patients who received a single 80 mg intramuscular gentamycin injection 30 minutes before the biopsy in addition to the same oral levofloxacin protocol as group 1. We recorded and analyzed data including age, indication for a TRUS biopsy of the prostate, prostate volume, comorbidity, infectious complications, blood and urine culture results.
Results: The mean PSA level was 38.653 ± 312.9249 ng/ml (range 4.4 – 2626 ng/ml) in group 1, and 34.843 ± 127.1309 ng/ml (range 2.11 – 1423 ng/ml) in group 2. The groups were similar in terms of mean age, indication for a biopsy, prostate volume and the number of biopsy cores taken, and comorbidities. Infectious-related complications occurred in 8 of 129 (3.0%) and 1 of 134 (0.4%) patients in groups 1 and 2, respectively (p = 0.02).
Conclusions: The addition of intramuscular 80 mg of gentamycin was beneficial in improving the efficacy of fluoroquinolone and reducing the post TRUS biopsy infection rate. Gentamycin is relatively inexpensive and readily available in daily practice and has good compliance for patient use.