title: Reduction in hospital admissions with the addition of prophylactic intramuscular ceftriaxone before transrectal ultrasonography-guided prostate biopsies.
abstract: OBJECTIVE
  To evaluate the hospitalization rates in 2 pre-prostate biopsy antibiotic protocols.
  
  
  METHODS
  Two prebiopsy protocols were compared. CiproAlone required ciprofloxacin 500 mg twice daily starting 1 day before biopsy and continuing for 3 days after biopsy (4 days total). Diabetic patients were prescribed ciprofloxacin for 4 days after biopsy. CiproCeft required 1 dose of oral ciprofloxacin 500 mg 1 hour before the biopsy and ceftriaxone 1 g intramuscular at the time of the biopsy. Hospitalization rates between the CiproAlone vs CiproCeft protocols were examined.
  
  
  RESULTS
  A total of 4134 biopsies were identified-2093 in the CiproAlone cohort and 2041 in the CiproCeft cohort. The post-prostate biopsy infection hospitalization rate was 0.6% (14 patients) in the CiproAlone group vs 0.0% (0 patients) in the CiproCeft group (P <.0001). Of the patients hospitalized, 12 fit systemic inflammatory response syndrome (SIRS) criteria. Eight of 14 hospitalized patients fit the sepsis (SIRS and source of infection) criteria. Positive cultures (urine and/or blood) resulted from 71% (n = 10) of hospitalized patients. Antibiotic resistance was analyzed. Diabetes mellitus was associated with hospitalization after prostate biopsy (P = .01) in our population, but there was no difference between the 2 groups in the rates of diabetes mellitus (P = .46). Patient age, prostate-specific antigen level, number of biopsy cores obtained, race, and previous antibiotics exposure were not found to be independent predictors of post-transrectal ultrasonography biopsy hospitalization for infection using a multivariate regression analysis.
  
  
  CONCLUSIONS
  A prophylactic prebiopsy protocol including 2 classes of antibiotics, single-dose ciprofloxacin, and single-dose intramuscular ceftriaxone reduced post-transrectal ultrasonography biopsy rates of hospitalizations compared to oral ciprofloxacin alone.
authors.affiliation: Department of Urology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Luong
authors.affiliation: Department of Urology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY.
authors.forename: Teresa
authors.initials: T
authors.lastname: Danforth
authors.affiliation: Department of Urology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Visnjevac
authors.affiliation: Department of Urology, the Western New York Urology Associates, LLC, Cheektowaga, NY.
authors.forename: Margaret
authors.initials: M
authors.lastname: Suraf
authors.affiliation: Department of Radiation Oncology, the Cancer Care of Western New York, Cheektowaga, NY. Electronic address: mduff@cancercarewny.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Duff
authors.affiliation: Department of Urology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY; Department of Urology, the Western New York Urology Associates, LLC, Cheektowaga, NY.
authors.forename: K Kent
authors.initials: KK
authors.lastname: Chevli
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000517:prevention & control*; D002443:Ceftriaxone / Q000008:administration & dosage*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D002443:Ceftriaxone