靶向抗生素预防经直肠前列腺穿刺术后感染的作用及相关危险因素

Efficacy of targeted antimicrobial prophylaxis using rectal swab cultures in preventing post transrectal prostate biopsy infection and in independent risk factors

目的探讨靶向抗生素预防经直肠前列腺穿刺活检术后感染的效果及可能导致感染的危险因素。方法回顾性收集经直肠前列腺穿刺活检的患者,分为经验组与靶向组。经验组患者经验性地选用第三代氟喹诺酮类抗生素(1 300例)。靶向组患者术前1~2周内进行肛拭子培养,对氟喹诺酮类耐药菌及产超广谱β内酰胺酶菌进行筛查,根据药敏结果靶向选用抗生素(131例)。主要观察终点为穿刺术后感染,收集各项临床资料试分析可能导致穿刺后感染的潜在危险因素。结果经验组与靶向组穿刺后感染率分别为67例(5.2%),1例(0.8%),采用靶向抗生素预防法可以显著地降低穿刺感染率(P=0.000)。肛拭子培养显示氟喹诺酮类耐药与产ESBL菌的携带率分别为48.9%,39.7%。单因素分析显示体重超重(BMI 25~28kg/m2)、肥胖(BMI>28kg/m2)、糖尿病可能与术后感染有关,多因素Logistic回归分析显示肥胖是前列腺穿刺后感染的独立危险因素(OR=11.897,95%CI:9.331~15.169,P=0.000)。结论采用靶向抗生素预防方案可以显著降低感染的发生率。肥胖可能是穿刺感染的危险因素。

Objective To evaluate the efficacy of targeted antimicrobial prophylaxis in preventing post transrectal prostate biopsy infection and to assess the potential risk factors.MethodsA total of 1 431 patients who underwent prostate biopsy were divided into 2 groups：empirical prophylaxis group（n=1 300）,and targeted prophylaxis group（n=131）.Rectal swab was cultured on selective media to identify fluoroquinolone resistant and ESBL producing bacteria.The relationship between post biopsy infection and clinical characteristics of patients was assessed.Data was first picked out in univariate analysis and then analyzed with multivariate logistic regression.ResultsAltogether 67 and 1 patients developed post-biopsy infection in the empirical prophylaxis group and targeted prophylaxis group,respectively.Targeted antimicrobial prophylaxis could significantly decrease the rate of post-biopsy infection（0.8% vs. 5.2%,P=0.000）.Escherichia coli were the most common pathogen causing infection.Rectal swab revealed as high as 48.9% and 39.7% patients harbored fluoroquinolone resistant and ESBL producing organisms respectively.In univariate analysis,overweight（BMI between 25-28）,obesity（BMI〉28）,and diabetes were the potential risk factors.Obesity was an independent risk factor（Odds Ratio=11.897,95%CI 9.331-15.169,P=0.000） in multivariable logistic regression.ConclusionTargeted antimicrobial prophylaxis is associated with a significant decrease in the incidence of post biopsy infection and obesity is an independent risk factor.