title: A single dose of meropenem is superior to ciprofloxacin in preventing infections after transrectal ultrasound-guided prostate biopsies in the era of quinolone resistance.
abstract: OBJECTIVE
  To evaluate the efficacy of meropenem single dose before transrectal prostate biopsy, instead of ciprofloxacin in the era of fluoroquinolones resistance.
  
  
  METHODS
  This prospective study included patients with indications for prostatic biopsy from January to December 2014. Those with known resistance in fluoroquinolones or meropenem or with decreased creatinine clearance were excluded. Patients were randomized into two groups, and statistical analysis was carried out. Group A received a 3-day course of ciprofloxacin 500 bid per os starting the day before biopsy. Group B received 1 g meropenem intravenously 1 h prior to the procedure. Patients were followed up for 15 days, and those with lower urinary tract symptoms (LUTS) and fever were called for hospitalization. Urine and blood cultures were obtained.
  
  
  RESULTS
  A total of 110 patients, 52-75 years old (mean 67.5, median 66) participated in the study, allocated in Groups A and B. After the procedure, 18 patients (32.7 %) of Group A reported macroscopic hematuria, while 10 (18.2 %) reported rectal blood loss. Nine patients (16.3 %) presented because of fever and LUTS. One of them developed septic shock and died in the ICU. Cultures revealed multi-resistant E. coli with high sensitivity to meropenem, and patients were treated accordingly. In Group B, 20 (36.3 %) patients presented with macroscopic hematuria and 9 (16.3 %) with rectal blood loss. One patient returned to hospital with LUTS and fever. Cultures revealed Klebsiella pneumoniae sensitive to colimycine.
  
  
  CONCLUSIONS
  A single dose of meropenem prior to prostate biopsy is a safe and effective way to avoid the possible infectious complications in high-risk patients.
authors.affiliation: Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece. mikesamih@hotmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Samarinas
authors.affiliation: Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimitropoulos
authors.affiliation: Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Zachos
authors.affiliation: Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Gravas
authors.affiliation: Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Karatzas
authors.affiliation: Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Tzortzis
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001707:Biopsy, Needle / Q000009:adverse effects*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D019160:Endosonography / Q000379:methods*; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects*; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D011446:Prospective Studies; D011469:Prostatic Diseases / Q000175:diagnosis; D012007:Rectum; D013845:Thienamycins / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D002939:Ciprofloxacin; D000077731:Meropenem
keywords: Fluoroquinolones resistance; Infectious complications; Meropenem; Transrectal prostate biopsy