title: Clinical importance of the antibiotic regimen in transrectal ultrasound-guided biopsy: quinolone versus cephalosporin.
abstract: BACKGROUND
  Quinolone is recommended as an antimicrobial prophylaxis to prevent infectious complication after transrectal ultrasound-guided biopsy, but the increased appearance of quinolone-resistant organism has raised concerns about the efficacy of quinolone. The current study was performed to evaluate various clinical factors including antimicrobial regimens associated with infectious complication after transrectal ultrasound-guided prostate biopsy.
  
  
  METHODS
  The medical records of 5215 patients who underwent a multicore transrectal ultrasound-guided prostate biopsy between May 2003 and January 2013 at our institution were reviewed. We analyzed clinical variables including prostate-specific antigen, International Prostate Symptom Score, antimicrobial regimen, prostate size, and number of biopsy cores. Univariate and multivariate logistic regression analyses of infection-related hospitalization after prostate biopsy were performed.
  
  
  RESULTS
  The mean age and median prostate-specific antigen of the entire cohort were 66 years and 6.4 ng/ml, respectively. Twenty-eight (0.54 %) patients developed an infectious complication after prostate biopsy that required hospitalization. Patients who received prophylactic quinolone showed a higher infectious hospitalization rate than patients who received prophylactic third-generation cephalosporin (1.5 vs. 0.3 %; p < 0.001). Multivariate logistic regression analysis demonstrated that the International Prostate Symptom Score (odds ratio = 3.18, 95 % confidence interval 1.24-8.13, p = 0.016) and the use of third-generation cephalosporin (odds ratio = 0.21, 95 % confidence interval 0.10-0.44, p < 0.001) were independent predictors of infection-related hospitalization after prostate biopsy.
  
  
  CONCLUSIONS
  With the emergence of quinolone-resistant microorganisms, third-generation cephalosporin may effectively reduce the risk of infectious complications after transrectal ultrasound-guided prostate biopsy. Severe lower urinary tract symptoms may also be an independent risk factor for infection-related hospitalization after transrectal ultrasound-guided prostate biopsy.
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, Gyunggi-do, 463-707, South Korea.|Department of Urology, College of Medicine, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.
authors.forename: Jung Keun
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, Gyunggi-do, 463-707, South Korea. uromedi@naver.com.|Department of Urology, College of Medicine, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea. uromedi@naver.com.
authors.forename: Sangchul
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, Gyunggi-do, 463-707, South Korea.|Department of Urology, College of Medicine, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, Gyunggi-do, 463-707, South Korea.|Department of Urology, College of Medicine, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam, Gyunggi-do, 463-707, South Korea.|Department of Urology, College of Medicine, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000517:prevention & control*; D002511:Cephalosporins / Q000627:therapeutic use*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D015363:Quinolones / Q000627:therapeutic use*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D015363:Quinolones
keywords: Antibiotics; Biopsy; Infection; Prostate; Transrectal ultrasound