title: Efficacy of two-time prophylactic intravenous administration of tazobactam/piperacillin for transrectal ultrasound-guided needle biopsy of the prostate.
abstract: BACKGROUND
  Prevalence of fluoroquinolone (FQ)-resistant Escherichia coli has been recently increasing worldwide. We analyzed the incidence and characteristics of acute bacterial prostatitis after transrectal ultrasound-guided needle prostate biopsy (TRUSP-Bx) with prophylactic tazobactam/piperacillin (TAZ/PIPC) treatment as an alternative regimen.
  
  
  METHODS
  A total of 391 patients who underwent TRUSP-Bx were included in the study. All patients received intravenous TAZ/PIPC (4.5 g) 30 minutes before and 6 hours after TRUSP-Bx.
  
  
  RESULTS
  Acute bacterial prostatitis developed in six patients (1.5%); the frequency of its occurrence was significantly higher in patients in whom rectal disinfection was not performed (P < 0.05). These six patients developed clinical symptoms of acute bacterial prostatitis a median of 24 hours after the biopsy. Escherichia coli was isolated in urine or blood bacterial cultures in four cases, and Klebsiella pneumoniae in two cases. All of the isolated organisms showed excellent sensitivity to TAZ/PIPC.
  
  
  CONCLUSIONS
  The incidence rate of acute prostatitis with prophylactic TAZ/PIPC was consistent with those reported previously with FQ-based regimens, despite the favorable sensitivity of isolated organisms. Two-time regimen of TAZ/PIPC may not always prevent the post-TRUSP-Bx infection, possibly due to the pharmacokinetic characteristics of TAZ/PIPC. However, if each case was considered individually to select the best setting and frequency of dosage of TAZ/PIPC, this can be an optimal prophylaxis in the era of widespread FQ-resistant microorganisms.
authors.affiliation: Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan ; Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Iwamoto
authors.affiliation: Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Shigehara
authors.affiliation: Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Miyagi
authors.affiliation: Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Nakashima
authors.affiliation: Department of Urology, Nomi City Hospital, Nomi, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Shimamura
authors.affiliation: Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Namiki
keywords: Acute bacterial prostatitis; Piperacillin/tazobactam; Prostate biopsy; Rectal disinfection