Infection-related complications secondary to quinolone resistance have been on the rise following transrectal ultrasound-guided biopsy of the prostate (TRUSBP). The aim of this review was to compare the efficacy of fosfomycin with quinolone-based antibiotic prophylaxis for TRUSBP.
A systematic review in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and Cochrane guidelines was conducted. All studies comparing fosfomycin vs. non-fosfomycin antimicrobial prophylaxis for TRUSBP were considered. The main outcomes were number of urinary tract infections (UTIs) (overall, afebrile, febrile, and urosepsis) and fluoroqinolone resistance. Secondary outcomes were positive urine and blood cultures, and adverse effects of drugs.
Five studies comparing fosfomycin and non-fosfomycin antimicrobials were included in the review. In all, 1447 and 1665 patients were included in the fosfomycin and non-fosfomycin cohorts, respectively. The systematic review report significantly lower UTIs in the fosfomycin cohort (M-H, Fixed, 95% CI), 0.20 (0.13, 0.30), p < 0.00001. Urine cultures from patients given fosfomycin showed significantly lower resistance rates (M-H, Fixed, 95% CI) 0.27 (0.15, 0.50), p < 0.0001. The adverse effect profile between the two cohorts were similar (M-H, Fixed, 95% CI) 1.13 (0.51, 2.50), p = 0.33. On Grade Pro evaluation, overall UTI, afebrile UTI, febrile UTI, and urosepsis were rates as moderate, low, very low, and moderate quality evidence, respectively. Positive blood and urine culture were rated as moderate and very low-quality evidence, respectively. Fluoroquinolone resistance was rated as low-quality evidence. Adverse effects was rated as very low-quality evidence.
This review suggests that fosfomycin has significantly lower septic complications with an equivalent side effect profile in comparison with quinolone-based prophylaxis regimen for TRUSBP. There is an urgent need for appropriate antibiotic stewardship and it is paramount that studies with robust methodology are developed to establish the role of fosfomycin over existing antibiotic regimens for TRUSBP.
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Carignan A, Roussy JF, Lapointe V, Valiquette L, Sabbagh R, Pepin J. Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis? Eur Urol. 2012;62:453–9.
Bootsma AM, Laguna Pes MP, Geerlings SE, Goossens A. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol. 2008;54:1270–86.
Yang M, Zhao X, Wu Z, Xiao N, Lu C. Meta-analysis of antibiotic prophylaxis use in transrectal prostatic biopsy. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009;34:115–23.
Kapoor DA, Klimberg IW, Malek GH, Wegenke JD, Cox CE, Patterson AL, et al. Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy. Urology. 1998;52:552–8.
Borghesi M, Ahmed H, Nam R, Schaeffer E, Schiavina R, Taneja S, et al. Complications after systematic, random, and image-guided prostate biopsy. Eur Urol. 2017;71:353–65.
Wagenlehner FME, van Oostrum E, Tenke P, Tandogdu Z, Çek M, Grabe M, et al. Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a Prospective Multinational Multicentre Prostate Biopsy Study. Eur Urol. 2013;63:521–7.
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. 2013;189(1 Suppl):S12–7.
Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Is repeat prostate biopsy associated with a greater risk of hospitalization? Data from SEER-Medicare. J Urol. 2013;189:867–70.
Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011;186:1830–4.
Anastasiadis E, van der Meulen J, Emberton M. Hospital admissions after transrectal ultrasound-guided biopsy of the prostate in men diagnosed with prostate cancer: a database analysis in England. Int J Urol. 2015;22:181–6.
Cai T, Gallelli L, Cocci A, Tiscione D, Verze P, Lanciotti M, et al. Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: fosfomycin trometamol, an attractive alternative. World J Urol. 2017;35:221–8.
Fahmy AM, Kotb A, Youssif TA, Abdeldiam H, Algebaly O, Elabbady A. Fosfomycin antimicrobial prophylaxis for transrectal ultrasound-guided biopsy of the prostate: a prospective randomised study. Arab J Urol. 2016;14:228–33.
Lista F, Redondo C, Meilan E, Garcia-Tello A, Ramon de Fata F, Angulo JC. Efficacy and safety of fosfomycin-trometamol in the prophylaxis for transrectal prostate biopsy. Prospective randomized comparison with ciprofloxacin. Actas Urol Esp. 2014;38:391–6.
Ongun S, Aslan G, Avkan-Oguz V. The effectiveness of single-dose fosfomycin as antimicrobial prophylaxis for patients undergoing transrectal ultrasound-guided biopsy of the prostate. Urol Int. 2012;89:439–44.
Sen V, Aydogdu O, Bozkurt IH, Yonguc T, Sen P, Polat S, et al. The use of prophylactic single-dose fosfomycin in patients who undergo transrectal ultrasound-guided prostate biopsy: a prospective, randomized, and controlled clinical study. Can Urol Assoc J. 2015;9:E863–7.
Schito GC, Naber KG, Botto H, Palou J, Mazzei T, Gualco L, et al. The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents. 2009;34:407–13.
Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available at: http://handbook.cochrane.org. Accessed March 2017.
Reeves, B, Shea, B, Wells, G. Classifying non-randomised studies (NRS) and the assessing the risk of bias for a systematic review. Paper presented at: Workshop at 18th Cochrane Colloquium; 2010; Keystone, CO, USA.: Cochrane Colloquium; 2010.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.
Nicasio AM, Kuti JL, Nicolau DP. The current state of multidrug-resistant Gram-negative bacilli in North America. Pharmacother J Human Pharmacol Drug Ther. 2008;28:235–49.
Yigit H, Queenan AM, Anderson GJ, Domenech-Sanchez A, Biddle JW, Steward CD, et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother. 2001;45:1151–61.
Gardiner BJ, Mahony AA, Ellis AG, Lawrentschuk N, Bolton DM, Zeglinski PT, et al. Is fosfomycin a potential treatment alternative for multidrug-resistant Gram-negative prostatitis? Clin Infect Dis. 2014;58:e101–5.
Nilsson AI, Berg OG, Aspevall O, Kahlmeter G, Andersson DI. Biological costs and mechanisms of fosfomycin resistance in Escherichia coli. Antimicrob Agents Chemother. 2003;47:2850–8.
NICE Guidelines. Multidrug resistant urinary tract infections: fosfomycin trometamol. 2013. Available at: https://www.nice.org.uk/advice/esuom17/chapter/key-points-from-the-evidence. Accessed 27 August 2017
Batura D, Gopal Rao G. The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention. J Antimicrob Chemother. 2013;68:247–9.
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The authors declare that they have no conflict of interest.
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Noreikaite, J., Jones, P., Fitzpatrick, J. et al. Fosfomycin vs. quinolone-based antibiotic prophylaxis for transrectal ultrasound-guided biopsy of the prostate: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 21, 153–160 (2018). https://doi.org/10.1038/s41391-018-0032-2
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