經直腸超音波攝護腺切片術後發燒及抗藥性菌種

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經直腸超音波攝護腺切片術後發燒及抗藥性菌種

石欣衛

1 、張兆祥1,2 、吳錫金1,2 、楊啟瑞1 、陳汶吉1,2 、 葉進仲1,2 、陳國樑1,2 、鄒頡龍1,2 、黃志平1 、陳至正1 、張士三1 中國醫藥大學附設醫院泌尿部1 ,中國醫藥大學醫學系2

Complication of fever after transrectal ultrasound guided prostate biopsy

and antibiotics-resistance of bacteria species

Hsin-Wei Shih1,Chao-Hsiang Chang1,2,Hsi-Chin Wu1,2,Che-Rei Yang1,Wen-Chi Chen1,2,Chin-Chung Yeh1,2,Kuo-Liang Chen1,2,Chieh-Lung Chou1,2,Chi-Ping Huang1,Chi-Cheng Chen1,Shin-San Chang1

1. Department of Urology,China Medical University Hospital 2. School of Medicine, China Medical University

Taichung, Taiwan

Purpose: The standard diagnosis of prostate cancer is by digital examination, PSA and pathology of

biopsy. Transrectal ultrasound guided prostate biopsy (TRUS biopsy) was general popularly received. The most serious complication of transrectal ultrasound guided prostate biopsy is bacterial sepsis. After biopsy the reported incidence of bacteremia is 16% to 73%.1–3 Bacteria is apparently introduced into the urine and/or blood from the rectum via the biopsy needle, which may be minimized by a pre-biopsy enema.4 However, infectious complications developed in around 0.1% to 10% of cases after prostate biopsy with antibiotic prophylaxis.5–9 The purpose of this study is to address the incidence rate of complication of fever after TRUS biopsy in a university hospital and the experience.

Material and Method: We made a retrospective study by reviewing the medical records of transrectal

ultrasound guided prostate biopsy (TRUS biopsy) between January 2009 and December 2011. The indication of biopsy was an increased PSA level or abnormal digital rectal examination. The patients who received TRUS biopsy will received oral prophylactic antibiotics with quinolone (Levofloxacin 500mg once daily or Ciprofloxacin 500mg twice daily) since the day of biopsy and then for 3 days. If the patient had antiplatelet or anticoagulation agents use, we instructed the patient hold for 5 days at least before biopsy. We also informed the patients who received TRUS biopsy that 24 hours telephone consultation number if there was fever or chills occurred. If the patient had fever or chills after TRUS biopsy, the patient was suggested to come to our emergent department and then admission.

Result: The total received TRUS biopsy number was 1168. There were 29 patients had fever (>38℃)

after TRUS biopsy. The incidence rate was 2.48%. There were 10 patients that had no bacterial growth of blood or urine but fever occurred and admission. There were 5 patients that had only bacterial growth of urine without bacteremia. The bacterial growth of urine were all the species of E.coli in these 5 patients. The bacteriemia occurred in 14 patients and there were 2 patients had severe uroseptic shock with respiratory failure and admitted to ICU care. The bacterial of blood were the species of E.coli except 1 patient had bacteremia with Citrobacter. There is no mortality occurred due to complication after TRUS biopsy. The sensitivity of antibiotics were all quinolone-resistance of bacteremia of E.coli in these 13 patients.

Conclusion: The prophylactic oral antibiotics with quinolone for 3 days since day of biopsy was still a

relative safety protocol for TRUS biopsy. If there was fever occurred after TRUS biopsy, the antibiotics of quinolone should be avoided due to high incidence rate of quinolone-resistance bacterial infection.

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相關主題 : 攝護腺用藥