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[Infectious complications following prostate biopsy-Major changes 2020].

Authors :
Pilatz A
Bonkat G
Wagenlehner F
Source :
Der Urologe. Ausg. A [Urologe A] 2020 Dec; Vol. 59 (12), pp. 1486-1491.
Publication Year :
2020

Abstract

Background: Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been suspended in Germany by the national authorities.<br />Objectives: This review is intended to highlight current strategies for reducing infectious complications following prostate biopsy.<br />Materials and Methods: The European Association of Urology (EAU) guideline group on urological infections recently published a meta-analysis in two parts based on randomized controlled trials (RCTs). The most important contents shall be presented here.<br />Results: Transperineal prostate biopsy is associated with significantly reduced infectious complications than transrectal biopsy. If transrectal biopsy is performed, intrarectal cleaning with povidone-iodine and antibiotic prophylaxis without fluoroquinolones should be chosen. Antibiotic prophylactic strategies include targeted prophylaxis after susceptibility testing of the rectal flora, augmented prophylaxis with multiple antibiotics and empiric monoprophylaxis with nonfluoroquinolones. Here data from RCTs are available for aminoglycosides, third generation cephalosporines, and fosfomycin trometamol.<br />Conclusions: The transperineal approach is preferred to reduce prostate biopsy-related infections. Fluoroquinolones are no longer approved for prophylaxis. Thus, alternative antibiotics based on local resistance, or targeted prophylaxis, in conjunction with povidone-iodine rectal preparation are recommended for transrectal prostate biopsy.

Details

Language :
German
ISSN :
1433-0563
Volume :
59
Issue :
12
Database :
MEDLINE
Journal :
Der Urologe. Ausg. A
Publication Type :
Academic Journal
Accession number :
33044635
Full Text :
https://doi.org/10.1007/s00120-020-01365-9