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Rational antibiotic sustainability for transrectal prostate biopsy prophylaxis

Nature Reviews Urology volume 14, page 696 (2017)Cite this article

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With regard to our article (Prophylactic antibiotic for prostate biopsy: the carbapenem gamble. Nat. Rev. Urol. 14, 394–396 (2017))1, we thank Maxim Bloomfield and Timothy Blackmore for their correspondence (Prophylactic ciprofloxacin for prostate biopsy: a losing bet? Nat. Rev. Urol. http://dx.doi.org/10.1038.org/nrurol.2017.154(2017))2. We applaud the work of Bloomfield and colleagues investigating the role of single-dose ertapenem prophylaxis in the development of selective carbapenem-resistant Enterobacteriaceae3; in fact, prospective studies in this domain are severely lacking.

Although the study was well executed, it is underpowered to detect changes in bacterial culture and clinical infection. It is well known that, despite fluoroquinolone-resistant faecal flora rates of ∼20%, only a small percentage of men undergoing transrectal ultrasonography-guided prostate biopsy (TRUPB) develop clinical infection and an even smaller percentage of those develop sepsis4,5. Indeed, in a population-based study using data from the English cancer registry of 198,361 men who underwent TRUPB, only 1.1% of patients developed UTI/sepsis6. It is common knowledge that overuse of crucial antibiotics by overtreating the vast majority of patients with these agents would not be a sound long-term solution. Moreover, it has become clear that certain patients will develop infection because either they harbour more virulent bacteria or the patient's inherent resistance to infection is compromised. This notion is best exemplified in one large study that demonstrated that 88% of men who developed sepsis were treated with an antibiotic to which the sepsis-causing organisms were culture-proven sensitive7.

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References

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  1. Deepak K. Pruthi and Michael A. Liss are at the Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229, USA.,

    Deepak K. Pruthi & Michael A Liss

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Correspondence to Michael A Liss.

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Pruthi, D., Liss, M. Rational antibiotic sustainability for transrectal prostate biopsy prophylaxis. Nat Rev Urol 14, 696 (2017). https://doi.org/10.1038/nrurol.2017.158

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