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. 2022 Feb 25;11(3):312.
doi: 10.3390/antibiotics11030312.

Recent Trends in Prostate Biopsy Complication Rates and the Role of Aztreonam in Periprocedural Antimicrobial Prophylaxis-A Nationwide Population-Based Study from Korea

Wook Nam  1 , Min Uk Park  2 , Han Kyu Chae  1 , Jihye Song  3 , Han Gwun Kim  1 , Jong Yeon Park  1 , Seokjoon Lee  4 , Sung Jin Kim  1
Affiliations

Recent Trends in Prostate Biopsy Complication Rates and the Role of Aztreonam in Periprocedural Antimicrobial Prophylaxis-A Nationwide Population-Based Study from Korea

Wook Nam et al. Antibiotics (Basel). .

Abstract

An increase in the rate of complications after prostate biopsy (PB) due to increased antibiotic-resistant bacteria is a global issue. We report the safety of aztreonam as a prophylactic antibiotic in patients undergoing PB. We investigated the complication rates according to several antibiotic regimens, including aztreonam. We hypothesized that PB complications increased following a rise in antibiotic-resistant bacteria. We examined the annual rates of complications among patients in our hospital (clinical cohort) and the Korea Health Insurance Review and Assessment Service (HIRA) cohort. Data regarding complications, hospitalization, emergency room (ER) visits, and febrile urinary tract infections occurring within 2 weeks after PB were recorded. The rate of complications was significantly lower in patients who received oral quinolone and intravenous aztreonam than in those who received oral quinolone. The complication rates did not increase throughout the study period. Additionally, 1754 patients from the HIRA cohort were included. The rates of complications, hospitalizations, and ER visits did not increase among these patients. Oral quinolone combined with intravenous aztreonam reduced the rate of febrile complications compared to quinolone alone and was safe to use after PB. Therefore, we recommend intravenous aztreonam with oral quinolone as a prophylactic antibiotic regimen before PB.

Keywords: aztreonam; prophylactic antibiotic; prostate biopsy; susceptibility.

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Conflict of interest statement

The authors declare no conflict of interest. The funding had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Patient flowchart for the clinical cohort. ER, emergency room; OPD, outpatient department; PB, transrectal-ultrasonography-guided prostate biopsy; SIRS, systemic inflammatory response syndrome.
Figure 2
Figure 2
Patient flowchart for The Korea Health Insurance Review and Assessment Service (HIRA) cohort. Group 1: patients who were prescribed oral quinolone as a prophylactic antibiotic for PB; Group 2: patients who were prescribed oral quinolone and intravenous aztreonam as prophylactic antibiotics for PB; Group 3: patients who were prescribed oral quinolones and intravenous aminoglycosides as prophylactic antibiotics for PB; Group 4: patients who were prescribed oral quinolones and intravenous quinolones as prophylactic antibiotics for PB. Cx4: patients with a history of visiting the ER; Cx5: patients with a history of hospitalization. IV, intravenous; PO, per oral.
Figure 3
Figure 3
The incidence of complications after PB in the clinical cohort according to the year. Groups accounting for 30% or more are displayed in bold. Cx1: patients who visited the ER or outpatient department as a complication of PB; Cx2: patients requiring hospitalization due to a complication of PB; Cx3: patients with a PB complication meeting the criteria for SIRS. Group 1: patients who were prescribed oral quinolone as a prophylactic antibiotic for PB; Group 2: patients who were prescribed oral quinolone and intravenous aztreonam as prophylactic antibiotics for PB; Group 3: patients who were prescribed oral quinolones and intravenous aminoglycosides as prophylactic antibiotics for PB; Group 4: patients who were prescribed oral quinolones and intravenous quinolones as prophylactic antibiotics for PB.
Figure 4
Figure 4
The incidence of complications after PB according to the year in the HIRA and clinical cohorts. PB: transrectal-ultrasonography-guided PB.
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