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首页> 美国卫生研究院文献>Open Access Journal of Urology >Impact of preoperative screening for rectal colonization with fluoroquinolone-resistant enteric bacteria on the incidence of sepsis following transrectal ultrasound guided prostate biopsy
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Impact of preoperative screening for rectal colonization with fluoroquinolone-resistant enteric bacteria on the incidence of sepsis following transrectal ultrasound guided prostate biopsy

机译：经直肠超声引导下前列腺穿刺活检术前筛查耐氟喹诺酮类肠细菌的直肠菌落对败血症发生率的影响

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With the universal adoption of antibiotic prophylaxis prior to prostate biopsy, the current risk of post-biopsy infection (including sepsis) is <2%. Preoperative prophylactic antibiotic regimens can vary, and although fluoroquinolones have emerged as the standard of care, there is no universally agreed upon preoperative antibiotic regimen. Recently, an increase in the proportion of postoperative infections caused by fluoroquinolone-resistant Escherichia coli (as well as other Enterobacteriaceae) has led to the exploration of simple, practical, and cost-effective methods to minimize this postoperative infection risk. We performed a prospective, nonrandomized, controlled study of preoperative rectal cultures to screen for rectal colonization with fluoroquinolone-resistant bacteria using ciprofloxacin-supplemented MacConkey agar culture media. To evaluate the feasibility and practicality of this test, one provider used the results of rectal swab cultures collected during the preoperative outpatient evaluation to adjust each patient’s preoperative antibiotic prophylaxis when fluoroquinolone-resistant enteric bacteria were detected, whereas two other providers continued usual preoperative care and empiric antimicrobial prophylaxis. Rectal colonization with fluoroquinolone-resistant bacteria was detected in 19/152 (12.5%) of patients. In our intention-to-treat analysis (N=268), the rate of post-biopsy sepsis was 3.6% lower in the group that was screened for rectal colonization with fluoroquinolone-resistant bacteria prior to transrectal prostate biopsy. The observed risk reduction in the rectal screening group trended toward, but did not achieve, statistical significance. We suggest that preoperative screening for rectal colonization with fluoroquinolone-resistant enteric bacteria may be a useful step toward mitigating post-prostate biopsy sepsis.
机译：随着前列腺穿刺术前普遍采用抗生素预防，目前活检后感染（包括败血症）的风险<2％。术前预防性抗生素方案可能会有所不同，尽管氟喹诺酮类已成为护理的标准，但术前抗生素方案尚无普遍共识。最近，由对氟喹诺酮类耐药的大肠杆菌（以及其他肠杆菌科）引起的术后感染比例的增加已导致探索一种简单，实用且经济高效的方法来尽量减少这种术后感染的风险。我们进行了一项术前直肠培养的前瞻性，非随机，对照研究，以使用环丙沙星补充的MacConkey琼脂培养基筛选抗氟喹诺酮类细菌的直肠定植。为了评估该测试的可行性和实用性，一个提供者使用了术前门诊评估期间收集的直肠拭子培养物的结果，以在检测到氟喹诺酮耐药肠细菌时调整每个患者的术前抗生素预防措施，而另外两个提供者则继续常规的术前护理和经验性的抗生素预防。在19/152（12.5％）的患者中检出了对氟喹诺酮类耐药菌的直肠定植。在我们的意向治疗分析中（N = 268），在经直肠前列腺活检之前筛查了氟喹诺酮耐药细菌的直肠定植的组中，活检后败血症的发生率降低了3.6％。在直肠筛查组中观察到的风险降低趋向于但未达到统计学显着性。我们建议术前筛查耐氟喹诺酮类肠细菌的直肠定植可能是减轻前列腺活检后败血症的有用步骤。

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