Adding amikacin to fluoroquinolone-based antimicrobial prophylaxis reduces prostate biopsy infection rates.

Author(s): Batura D, Rao GG, Bo Nielsen P, Charlett A

Affiliation(s): Department of Urology, Northwick Park Hospital, London, UK. Deepakbatura@gmail.com

Publication date & source: 2011-03, BJU Int., 107(5):760-4. Epub 2010 Oct 4.

OBJECTIVE: * To examine the efficacy of adding amikacin to fluoroquinolone-based antimicrobial prophylaxis in preventing transrectal ultrasonography-guided prostate biopsy (TGB) associated infections. PATIENTS AND METHODS: * Infections after TGB were compared before adding amikacin to antimicrobial prophylaxis (2006) with those that occurred after adding amikacin to the prophylaxis (2007 and 2008). * During both periods antimicrobial prophylaxis consisted of ciprofloxacin, co-amoxiclav and metronidazole except after August 2008 when co-amoxiclav was discontinued. * Amikacin was added to the prophylaxis protocol in the period 2007 and 2008. RESULTS: * Before adding amikacin 11 of 281 (3.9%) patients developed infections after TGB (seven urinary tract infections (UTIs) and seven bacteraemias) whereas after adding amikacin six UTIs and two bacteraemias occurred in 590 (1.4%) patients. * In both periods, most of the strains causing the infections were ciprofloxacin resistant (2006: 13 of 14; 2007 and 2008: seven of eight). * Overall, there is strong statistical evidence that the total infection rate was significantly reduced after the inclusion of amikacin into the prostate biopsy prophylaxis regimen. * In 2007 and 2008 when amikacin was included in prophylaxis, the bacteraemia rate was reduced to just over one-tenth of the rate in 2006 before introducing amikacin (P= 0.002). * Although just failing to reach the conventional significance level of 0.05, the evidence suggests a reduction in UTI by an estimated 60% after adding amikacin. CONCLUSION: * We conclude that adding amikacin to fluoroquinolone-based antimicrobial prophylaxis in areas with high fluoroquinolone resistance confers significant benefit in preventing infections after TGB. (c) 2010 THE AUTHORS. BJU INTERNATIONAL (c) 2010 BJU INTERNATIONAL.