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A single dose of piperacillin-tazobactam for the prophylaxis of febrile complications in transrectal needle biopsy of the prostate

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... Even though they may be following the advice of international guidelines, the rates of infective complications due to the increased resistance to fluoroquinolones after prostate biopsy are 2.4---7.5%. 11 In our institution, a previous study encouraged the use of a single dose of piperacillin/tazobactam before the biopsy as prophylaxis in prostate biopsy due to high resistance to narrower-spectrum antibiotics. 11 According to recent results from our institution that are awaiting publication, the best options at our hospital might be: amikacin, ertapenem, fosfomycin, and nitrofurantoin. ...
... 11 In our institution, a previous study encouraged the use of a single dose of piperacillin/tazobactam before the biopsy as prophylaxis in prostate biopsy due to high resistance to narrower-spectrum antibiotics. 11 According to recent results from our institution that are awaiting publication, the best options at our hospital might be: amikacin, ertapenem, fosfomycin, and nitrofurantoin. We conclude that quinolones should not be used as antibiotic prophylaxis and the decision-making should be tailored according to local resistance patterns. ...
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Background: Prostate cancer is the first cause of mortality related to malignancy in Mexican men. Common clinical practice has to be evaluated in order to gain a picture of reality apart from the guidelines. Aim: To analyze clinical practice among urologists in Mexico in relation to prostate cancer management and to compare the results with current recommendations and guidelines. Methods: We collected the data from 600 urologists, members of the Sociedad Mexicana de Urología, who were invited by email to answer a survey on their usual decisions when managing controversial aspects of prostate cancer patients. Results: Quinolones were the most common antibiotic used as prophylaxis in prostate biopsy (75.51%); 10-12 cores were taken in more than 65% of prostate biopsies; and 18.27% of the participants performed limited pelvic lymphadenectomy. Treatment results showed that 10.75% of the urologists surveyed preferred radical prostatectomy as monotherapy in high-risk patients with extraprostatic extension and 60.47% used complete androgen deprivation in metastatic prostate cancer. Conclusions: There are many areas of opportunity for improvement in our current clinical practice for the management of patients with prostate cancer.
... dose of piperacillin/tazobactam (P---T). 9 In this study we described the complications of TRPB, emphasizing infectious complications, with the use of this prophylactic regime. ...
... The majority of isolated microorganisms, particularly those causing bacteremia, were ESBL-producing strains that were also resistant to quinolones. 12 We and others have previously reported the experience with a single dose of PT as antimicrobial prophylaxis 9,13 or in combination with quinolones. 14 The use of a single dose of antibiotic prophylaxis is an appealing strategy, 15 particularly in countries with a higher prevalence of resistant microorganisms. ...
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Background: The increasing resistance to quinolones has led to the consideration of other antibiotic options for the prevention of infectious complications in prostate biopsy. We present our experience using a single dose of piperacillin/tazobactam as prophylaxis. Methods: A retrospective study of transrectal prostate biopsies performed at our institution from 2008 to 2013 was conducted. All patients received enemas before biopsy and a single 4.5. g dose of piperacillin/tazobactam was administered i.v. a few minutes before the biopsy. Clinical and microbiological variables were analyzed to find out risk factors for complications. Results: A total of 543 biopsies were included. Ninety-two complications (16.9%) were reported in 74 (13.6%) patients, 4.2% of which were infectious complications. In these patients, the associated risk factors were a previous history of positive urine cultures within a 3-year period before biopsy, the presence of a transurethral indwelling catheter at the time of the biopsy, hospital admission within a month before biopsy, and a preoperative positive urine culture despite antibiotic therapy selected according to the resistance pattern. Conclusions: Physicians and patients should be aware of the risk for complications, particularly if risk factors are present. A single dose of piperacillin/tazobactam is a reasonable option for prophylaxis, especially in countries with a high prevalence of quinolone-resistant pathogens. Objetivo: Materiales and Métodos: Resultados: Conclusiones:
... Patients were categorised on basis of Without Chronic Prostatitis and With Chronic Prostatitis. Procedure technique and antibiotic prophylaxis which was followed and persuade was reported at early by several time [8,9] . CP was defined as "Category IV" according to the NIH classification of prostatitis syndromes (asymptomatic inflammatory prostatitis). ...
... dose of piperacillin/tazobactam was administered 15 min before the procedure. 20 We used an 18-gauge needle with an automatic biopsy gun to obtain the prostatic tissue. For the first biopsy, 12---18 cores were retrieved, depending on the size of the prostate and the presence of suspicious nodules. ...
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Conservative therapies, such as active surveillance, can be appropriate treatment for low-risk prostate cancer. The aim of this study was to analyze the frequency of Gleason score (GS) upgrading in patients with a low-grade GS. We reviewed our prospectively maintained database of patients with prostate cancer that underwent radical prostatectomy within the time frame of 2004–2015. Potential predictors of upgrading in patients with GS 3+3 were studied. Of the 342 patients in our database, 125 had GS 3+3. Biopsy GS and surgical GS were identical in 71 (56.8%) patients with GS 3+3, whereas 54 (43.2%) patients had an upgrade. The GS was upgraded to 7 in 70% of those patients and to ≥8 in 30%. We found a statistically significant correlation between postoperative upgrade and the preoperative prostate-specific antigen density (PSAD) value (p<0.001), prostate volume (p=0.004), and patient age ≥70 years (p=0.011). We estimated an optimal PSAD cutoff point of 0.17ng/ml² through ROC analysis, with an AUC of 0.675 (p=0.001). It is our opinion that every hospital center offering active surveillance should carry out a continuous review of upgrading and related risk factors.
... A retrospective analysis of our institutional database of TRPB performed from January 2008 to June 2013 was performed. The procedure technique and antibiotic prophylaxis used at our Institution have been previously reported [8,9]. Only patients with complete medical records were included. ...
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Prostate cancer is the most frequent tumor found in men worldwide and in Mexico in particular. Age and family his- tory are the main risk factors. The diagnosis is made by prostate biopsy in patients with abnormalities detected in their prostate-specific antigen (PSA) levels or digital rectal exam (DRE). This article reviews screening and diagnostic methods as well as treatment options for patients diagnosed with prostate cancer. DOI:?http://dx.doi.org/10.21149/spm.v58i2.7797
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We determined whether increasing the number of cores at first prostate biopsy would improve the cancer detection rate without increasing the detection of clinically insignificant tumors. From January 2009 to January 2010 patients scheduled for prostate biopsy were randomized to 12 or 18-core sampling. Study inclusion criteria were 1) age 45 to 75 years, 2) abnormal digital rectal examination and/or prostate specific antigen 4 to 20 ng/ml, and 3) no previous biopsy. The primary end point was the cancer detection rate. Secondary end points were clinically insignificant cancer detection and morbidity. A total of 150 patients were enrolled in the study. Preoperative variables were similar in the 2 groups of 75 patients each. Cancer was detected in 23 patients (30.7%) in group 1 and in 36 (48%) in group 2 (p = 0.02). More cases of insignificant cancer were detected in group 2 (p not significant). In men with prostate volume 65 cc or less the detection rate was 30.9% in group 1 and 52.8% in group 2 (p = 0.02). In men with prostate specific antigen 10 ng/ml or less the detection rate was 19.6% in group 1 and 38.4% in group 2 (p = 0.03). Two group 2 patients (5.5%) were diagnosed based on additional samples but the diagnosis corresponded to insignificant cancer. There was no statistically significant difference in morbidity. The 18-core protocol improves prostate cancer detection without increasing morbidity. Results suggest that the 12-core biopsy protocol is adequate for prostate cancer detection at first biopsy.
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