单剂量头孢美唑和左氧氟沙星经直肠超声引导前列腺活检减少感染并发症和医疗费用。

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2025-05-01 DOI:10.1016/j.urolonc.2025.01.017

Katsuhiro Onishi , Hiroshi Morioka MD, PhD , Kazuki Nishida MD, PhD , Masashi Yamamoto , Daisuke Tsuchimoto , Yoshie Moriya MD , Osamu Kamihira MD, PhD

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引用次数: 0

摘要

简介：氟喹诺酮类药物（FQ）目前是经直肠超声引导前列腺活检（TRUS-PBx）的首选预防药物。然而，由fq耐药或产生广谱β-内酰胺酶的大肠杆菌引起的感染仍然值得关注。虽然头孢美唑（CMZ）对这些耐药大肠杆菌菌株有效，但在TRUS-PBx中使用的报道很少。我们研究了静脉注射CMZ和口服左氧氟沙星（LVFX）对TRUS-PBx的抗菌预防（AP）效果。方法：本研究于2014年1月至2023年12月在日本小木市医院进行单中心回顾性观察前后研究。比较接受单剂量静脉注射头孢唑林（CEZ）和口服LVFX的患者与接受单剂量静脉注射CMZ和口服LVFX的患者在TRUS-PBx后发热性尿路感染（UTI）、尿脓毒症、菌血症、再入院、脓肿和医疗相关费用的发生率。采用多变量logistic分析对trus - pbx术后发热性尿路感染的危险因素进行分析。结果：CEZ+LVFX组TRUS-PBx术后发热性尿路感染发生率为0.77% (9/ 1168)，CMZ+LVFX组为0.20%（2/ 1008）。仅CEZ+LVFX组出现尿脓毒症（5例）、菌血症（3例）、脓肿（2例）、再入院（3例）等并发症。多变量分析表明，使用CMZ+LVFX可显著降低TRUS-PBx术后发热性UTI（优势比：0.20,95%可信区间：0.04-0.98,P = 0.047）。与CEZ+LVFX相比，使用CMZ+LVFX可将每个TRUS-PBx的医疗相关成本降低975.5日元（6.8美元）。结论：在TRUS-PBx前使用CMZ+LVFX的经验性AP降低了感染并发症的发生率和医疗保健相关费用。

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Reducing infectious complications and healthcare costs in transrectal ultrasound-guided prostate biopsy with single-dose cefmetazole and levofloxacin

Introduction

Fluoroquinolones (FQ) are currently the first choice as prophylactics for transrectal ultrasound-guided prostate biopsy (TRUS-PBx). However, infections caused by FQ-resistant or extended-spectrum β-lactamase producing Escherichia coli remain a significant concern. Although cefmetazole (CMZ) is effective against these resistant E. coli strains, there are only a few reports on its use in TRUS-PBx. We investigated the efficacy of antimicrobial prophylaxis (AP) for TRUS-PBx using intravenous CMZ and oral levofloxacin (LVFX).

Methods

This single-center retrospective observational before-and-after study was conducted between January 2014 and December 2023 at Komaki City Hospital, Japan. The incidence of febrile urinary tract infection (UTI), urosepsis, bacteremia, readmission, abscess, and healthcare-related costs after TRUS-PBx were compared between individuals who received a single dose of intravenous cefazolin (CEZ) and oral LVFX and those who received single doses of intravenous CMZ and oral LVFX. The risk factors for post-TRUS-PBx febrile UTI were analyzed using multivariable logistic analysis.

Results

The incidence of febrile UTI after TRUS-PBx was 0.77% (9/1,168) in the CEZ+LVFX group and 0.20% (2/1,008) in the CMZ+LVFX group. Complications such as urosepsis (5 cases), bacteremia (3 cases), abscess (2 cases), and readmission (3 cases) were observed only in the CEZ+LVFX group. Multivariable analysis indicated that the use of CMZ+LVFX significantly decreased febrile UTI after TRUS-PBx (odds ratio: 0.20, 95% confidence interval: 0.04–0.98, P = 0.047). CMZ+LVFX use reduced healthcare-related costs by JPY 975.5 (USD 6.8) per TRUS-PBx compared to CEZ+LVFX.

Conclusions

Empirical AP with CMZ+LVFX before TRUS-PBx reduced the incidence of infectious complications and healthcare-related costs.

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.