title: Antibiotic prophylaxis for transrectal prostate biopsy-a new strategy.
abstract: BACKGROUND
  Fluoroquinolones are extensively used as prophylaxis for transrectal ultrasound-guided biopsy of the prostate (TRUBP). Emerging fluoroquinolone resistance and selection of multiresistant organisms warrant new prophylactic strategies. Pivmecillinam and amoxicillin/clavulanic acid have mutual synergistic activity and the combination of these agents has a broad coverage of the majority of microorganisms causing infectious complications after TRUBP and may be a valuable future prophylactic regimen.
  
  
  METHODS
  This was a retrospective cohort study of 2624 men that underwent TRUBP at a Danish university hospital. The patients were divided into three groups. Group 1 (n = 1220) received ciprofloxacin before TRUBP, Group 2 (n = 240) received a combination of pivmecillinam and amoxicillin/clavulanic acid before TRUBP and Group 3 (n = 1161) received an extended prophylaxis with pivmecillinam and amoxicillin/clavulanic acid before and for 2 days after TRUBP.
  
  
  RESULTS
  One hundred and ten out of 148 (74.3%) post-TRUBP infections were caused by Escherichia coli, Klebsiella pneumoniae or Enterococcus faecalis. Group 3 with the extended prophylaxis with pivmecillinam and amoxicillin/clavulanic acid had a significantly lower rate of bacteraemia (0.9%) as compared with Group 1 (1.8%) and Group 2 (3.7%). A significant fall in the proportion of ESBL-producing Enterobacteriaceae was observed from the period when ciprofloxacin was used as prophylaxis (8.1%) compared with the subsequent period when pivmecillinam and amoxicillin/clavulanic acid was used (5.9%).
  
  
  CONCLUSIONS
  The combination of pivmecillinam and amoxicillin/clavulanic acid is an attractive prophylaxis for TRUBP from a clinical, bacteriological and ecological point of view as compared with ciprofloxacin.
authors.affiliation: Department of Clinical Microbiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark valeria.antsupova@yahoo.dk.
authors.forename: Valeria
authors.initials: V
authors.lastname: Antsupova
authors.affiliation: Department of Urology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Nis
authors.initials: N
authors.lastname: Nørgaard
authors.affiliation: Department of Urology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Bisbjerg
authors.affiliation: Department of Clinical Microbiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Jette
authors.initials: J
authors.lastname: Nygaard Jensen
authors.affiliation: Department of Clinical Microbiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark Capital Region Pharmacy, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Jonas
authors.initials: J
authors.lastname: Boel
authors.affiliation: Department of Clinical Microbiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Jens Otto
authors.initials: JO
authors.lastname: Jarløv
authors.affiliation: Department of Clinical Microbiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Magnus
authors.initials: M
authors.lastname: Arpi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001424:Bacterial Infections / Q000517:prevention & control*; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D003718:Denmark; D004359:Drug Therapy, Combination / Q000379:methods; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: amoxicillin/clavulanic acid; ciproﬂoxacin; pivmecillinam; prophylaxis; prostate biopsy