Fosfomycin-trometamol (FT) or fluoroquinolone (FQ) as single-dose prophylaxis for transrectal ultrasound-guided prostate biopsy (TRUS-PB): A prospective cohort study. (January 2021)

• Record Type: Journal Article
• Authors: Delory, Tristan; Goujon, Annabelle; Masson-Lecomte, Alexandra; Arias, Pauline; Laurancon-Fretar, Anthony; Bercot, Béatrice; Mongiat-Artus, Pierre; Molina, Jean-Michel; Lafaurie, Matthieu
• Is Part Of: International journal of infectious diseases. Volume 102(2021)
• Page Start: 269
• Page End: 274
• Publication Date: 2021-01
• Subjects: ANSM Agence Nationale de Sécurité du Médicament et des produits de santé -- AUA American Urological Association -- FQ Fluoroquinolones -- FT Fosfomycin-trometamol -- CI 95% 95% confidence interval -- IDSA Infectious Disease Society of America -- IQR interquartile range -- MRI Magnetic resonance imaging -- RR Relative risk -- STROBE Strengthening the Reporting of Observational Studies in Epidemiology -- TRUS-PB Transrectal ultrasound-guided prostate biopsy -- UTI Urinary tract infection; Fosfomycin -- Fluoroquinolones -- Prophylaxis -- Prostate Biopsy -- Cohort study; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.10.065
• Languages: English
• ISSNs: 1201-9712

Abstract

Graphical abstract: Highlights: Resistance to fluoroquinolones (FQ) is increasing in urinary tract infection related to prostate biopsy. Fosfomycin-trometamol (FT) is a possible alternative to FQ for antimicrobial prophylaxis in prostate biopsy. FT seems to be as effective as and as safe as FQ. Noninferiority, double-blind randomized comparison of FT versus FQ is required. Abstract: Objectives: The increasing incidence of fluoroquinolones (FQ) resistance may lower its efficacy in preventing UTI following transrectal ultrasound-guided prostate biopsy (TRUS-PB). We assessed the efficacy and safety of FQ and fosfomycin-trometamol (FT) in patients undergoing TRUS-PB. Methods: A prospective observational study was conducted between April 2017 and June 2019 and enrolled men undergoing TRUS-PB and receiving a single-dose of FQ (FQ-arm) or FT (FT-arm) for UTI prophylaxis per physician's choice. The primary efficacy endpoint was self-reported TRUS-PB UTI. We assessed baseline factors associated with UTI with logistic regression. Results: A total of 222 men were enrolled, 141/222 (64%) received FQ, and 81/222 (36%) FT. The median age was 67.6 years [IQR, 61.4–72.1] and the Charlson score was 3 [IQR, 3–5]. The overall incidence of self-reported TRUS-PB UTI was 12% (24/197, (95%CI, 8%–17%)): 15% (17/116, (95% CI, 10%–17%)) in FQ-arm, versus 9% (7/81, 95% CI (5%–13%)) in FT-arm (RR = 0.55 (95% CI, 0.22–1.40), p-value = 0.209). No baseline characteristic was significantly associated with TRUS-PB UTI. Safety was similar between the arms: the rate of the reported adverse event was 31% (36/116, (95% CI, 25%–37%) in the FQ-arm versus 36% (28/81, (95% CI, 28%–41%)) in the FT-arm (RR = 1.17 (95% CI, 0.64–2.15), p = 0.602). Conclusions: TRUS-PB UTI prophylaxis with FT and FQ has similar efficacy and safety. A randomized comparison of these two antibiotics is warranted.