Reducing infectious complications and healthcare costs in transrectal ultrasound-guided prostate biopsy with single-dose cefmetazole and levofloxacin.

Katsuhiro Onishi, Hiroshi Morioka, Kazuki Nishida, Masashi Yamamoto, Daisuke Tsuchimoto, Yoshie Moriya, Osamu Kamihira
{"title":"Reducing infectious complications and healthcare costs in transrectal ultrasound-guided prostate biopsy with single-dose cefmetazole and levofloxacin.","authors":"Katsuhiro Onishi, Hiroshi Morioka, Kazuki Nishida, Masashi Yamamoto, Daisuke Tsuchimoto, Yoshie Moriya, Osamu Kamihira","doi":"10.1016/j.urolonc.2025.01.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Fluoroquinolones (FQ) are currently the first choice as prophylactics for transrectal ultrasound-guided prostate biopsy (TRUS-PBx). However, infections caused by FQ-resistant or extended-spectrum β-lactamase producing Escherichia coli remain a significant concern. Although cefmetazole (CMZ) is effective against these resistant E. coli strains, there are only a few reports on its use in TRUS-PBx. We investigated the efficacy of antimicrobial prophylaxis (AP) for TRUS-PBx using intravenous CMZ and oral levofloxacin (LVFX).</p><p><strong>Methods: </strong>This single-center retrospective observational before-and-after study was conducted between January 2014 and December 2023 at Komaki City Hospital, Japan. The incidence of febrile urinary tract infection (UTI), urosepsis, bacteremia, readmission, abscess, and healthcare-related costs after TRUS-PBx were compared between individuals who received a single dose of intravenous cefazolin (CEZ) and oral LVFX and those who received single doses of intravenous CMZ and oral LVFX. The risk factors for post-TRUS-PBx febrile UTI were analyzed using multivariable logistic analysis.</p><p><strong>Results: </strong>The incidence of febrile UTI after TRUS-PBx was 0.77% (9/1,168) in the CEZ+LVFX group and 0.20% (2/1,008) in the CMZ+LVFX group. Complications such as urosepsis (5 cases), bacteremia (3 cases), abscess (2 cases), and readmission (3 cases) were observed only in the CEZ+LVFX group. Multivariable analysis indicated that the use of CMZ+LVFX significantly decreased febrile UTI after TRUS-PBx (odds ratio: 0.20, 95% confidence interval: 0.04-0.98, P = 0.047). CMZ+LVFX use reduced healthcare-related costs by JPY 975.5 (USD 6.8) per TRUS-PBx compared to CEZ+LVFX.</p><p><strong>Conclusions: </strong>Empirical AP with CMZ+LVFX before TRUS-PBx reduced the incidence of infectious complications and healthcare-related costs.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urologic Oncology-seminars and Original Investigations","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.urolonc.2025.01.017","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: Fluoroquinolones (FQ) are currently the first choice as prophylactics for transrectal ultrasound-guided prostate biopsy (TRUS-PBx). However, infections caused by FQ-resistant or extended-spectrum β-lactamase producing Escherichia coli remain a significant concern. Although cefmetazole (CMZ) is effective against these resistant E. coli strains, there are only a few reports on its use in TRUS-PBx. We investigated the efficacy of antimicrobial prophylaxis (AP) for TRUS-PBx using intravenous CMZ and oral levofloxacin (LVFX).

Methods: This single-center retrospective observational before-and-after study was conducted between January 2014 and December 2023 at Komaki City Hospital, Japan. The incidence of febrile urinary tract infection (UTI), urosepsis, bacteremia, readmission, abscess, and healthcare-related costs after TRUS-PBx were compared between individuals who received a single dose of intravenous cefazolin (CEZ) and oral LVFX and those who received single doses of intravenous CMZ and oral LVFX. The risk factors for post-TRUS-PBx febrile UTI were analyzed using multivariable logistic analysis.

Results: The incidence of febrile UTI after TRUS-PBx was 0.77% (9/1,168) in the CEZ+LVFX group and 0.20% (2/1,008) in the CMZ+LVFX group. Complications such as urosepsis (5 cases), bacteremia (3 cases), abscess (2 cases), and readmission (3 cases) were observed only in the CEZ+LVFX group. Multivariable analysis indicated that the use of CMZ+LVFX significantly decreased febrile UTI after TRUS-PBx (odds ratio: 0.20, 95% confidence interval: 0.04-0.98, P = 0.047). CMZ+LVFX use reduced healthcare-related costs by JPY 975.5 (USD 6.8) per TRUS-PBx compared to CEZ+LVFX.

Conclusions: Empirical AP with CMZ+LVFX before TRUS-PBx reduced the incidence of infectious complications and healthcare-related costs.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
4.80
自引率
3.70%
发文量
297
审稿时长
7.6 weeks
期刊介绍: Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.
期刊最新文献
Reducing infectious complications and healthcare costs in transrectal ultrasound-guided prostate biopsy with single-dose cefmetazole and levofloxacin. SIRI as a biomarker for bladder neoplasm: Utilizing decision curve analysis to evaluate clinical net benefit. Multicenter study of active surveillance for small renal masses: Real world practice pattern. Rethinking the definition of stage III disease in adrenocortical carcinoma: Assessing the impact of clinical lymph node positive disease. Concordance of surgical treatment selection with the AUA guidelines for localized renal masses.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1