Data build for pre-Bx targeted prophylaxis

An article in the June 2014 issue of Urology Times builds on the observations first published by Taylor et al at Northwestern (J Urol 2012; 187:1275-9) that infectious complications associated with transrectal ultrasound-guided prostate biopsy can be reduced by directed versus empiric prophylaxis. It is interesting to note that the worldwide prevalence of fluoroquinolone resistance continues to be approximately 20%. The patients who had ciprofloxacin-resistant flora and received directed prophylaxis appeared to do as well as those who had ciprofloxacin-sensitive bacteria and received ciprofloxacin.

The author’s comment that, “We believe our study provides the most definitive data on post-biopsy infection risk according to fluoroquinolone-resistant colonization status to date” should be rephrased to indicate that this current study supports earlier observations that fluoroquinolone-resistant status is relevant and that targeted prophylaxis can reduce the risk of infection.

The downside to targeted prophylaxis guided by rectal culture (as noted in the article by Taylor and colleagues) are the costs and the need to provide more expensive drugs for some patients with ciprofloxacin-resistant flora. However, the upsides are that the serious complications such as urosepsis are significantly less, and hence, the overall costs for a population will be reduced.

In summary, this study adds to the growing literature on the advantages of targeted prophylaxis and suggests that practicing urologists should strongly consider this approach.UT

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