Emine Sehmen, Önder Çınar, Mustafa BOLAT

Transrektal Ultrason Eşliğinde Prostat Biyopsisi Profilaksisinde Çift Doz Fosfomisin ile Siprofloksasinin Karşılaştırılması

Amaç: Transrektal ultrason eşliğinde yapılan prostat biyopsisi (TRİB) profilaksisinde fosfomisin ve siprofloksasin kullanımı sonrasında gelişen enfeksiyöz komplikasyonların ve bu komplikasyonları kolaylaştıracak risk faktörlerini ortaya çıkarmaktır. Gereç ve Yöntemler: Ekim 2018 ve Ekim 2020 tarihleri arasında gerçekleştirilen toplam 281 TRİB olgunun tıbbi kayıtları retrospektif olarak incelendi. Olgular profilaktik antibiyotik kullanımına göre Grup 1 (siprofloksasin grubu, n=216) ve Grup 2 (fosfomisin grubu, n=65) olmak üzere ikiye ayrıldı. Ortalama yaş, vücut kitle indeksi (VKİ), prostat spesifik antijen (PSA) düzeyi, prostat hacmi (PV), histopatolojik tanı ve sistemik enfeksiyona neden olabilecek risk faktörleri incelendi. Hastaların enfeksiyöz komplikasyonları epididimit, prostatit, pyelonefrit ya da ürosepsis kategorilerinde değerlendirildi. Bulgular: Hastalardan Grup 1 ve Grup 2’ye ayrılanların sırasıyla; ortalama yaşı 64,9±10,8 ve 64,3±7,3 yıl, VKİ 26,6±4,6 ve 27,3±3,8; total PSA düzeyleri 12,3±26,2 ve 11,9±18,4 ng/mL; PV 62,6±80,6 ve 58,9±35,4 cc idi. Grup 1’de 171 (%79,2) hastada, Grup 2’de ise 60 (%92,3) hastada komorbidite saptanmadı. Grup 1’de 5 olguda (%2,3), Grup 2’de bir olguda (%1,5) olmak üzere toplam 6 olguda enfeksiyöz komplikasyon gelişti (%2,1) ve enfeksiyon oranı bakımından gruplar arasında fark gözlenmedi (p=0,21). İki grupta da yaş, VKİ, PV, PSA düzeyi gibi parametrelerle diabetes mellitus ve hipertansiyon gibi komorbiditeler febril komplikasyonları predispoze etmedi (R2=0,085 (Cox-Snell), R2=0,486 (Nagelkerke), p=0,051). Sonuç: TRİB profilaksisinde oral siprofloksasin ve fosfomisin uygulaması benzer enfeksiyöz komplikas- yon oranlarına sahiptir. Siprofloksasine karşı antibiyotik direncinin artışı da dikkate alındığında, fosfomi- sin kabul edilebilir enfeksiyöz komplikasyon oranlarıyla tercih edilebilir bir ajan olarak öne çıkmaktadır.

Comparison of Double Dose Fosfomycin and Ciprofloxacin in The Prophylaxis of Transrectal Ultrasound Guided Prostate Biopsy

Aim: To evaluate the infectious complications that develop after the use of fosfomycin and ciprofloxacin in the prophylaxis of transrectal ultrasound-guided prostate biopsy (TRIB) and the risk factors that will facilitate these complications. Materials and Methods: The medical records of 281 TRIB cases conducted between October 2018 and October 2020 were retrospectively analyzed. Patients were divided into two groups according to the use of prophylactic antibiotics as Group 1 (ciprofloxacin group, n = 216) and Group 2 (fosfomycin group, n = 65). Mean age, body mass index (BMI), prostate specific antigen (PSA) level, prostate volume (PV), histopathological diagnosis and risk factors that could cause systemic infection were examined. The infectious complications of the patients were evaluated in the categories of epididymitis, prostatitis, pyelonephritis or urosepsis. Results: Of the patients divided into Group 1 and Group 2; mean age was 64.9 ± 10.8 and 64.3 ± 7.3 years, BMI was 26.6 ± 4.6 and 27.3 ± 3.8; total PSA levels were 12.3 ± 26.2 and 11.9 ± 18.4 ng / mL; and PV was 62.6 ± 80.6 and 58.9 ± 35.4 cc., respectively. Conclusion: Oral ciprofloxacin and fosfomycin administration in TRIB prophylaxis has similar infectious complication rates. Considering the increased antibiotic resistance to ciprofloxacin, fosfomycin stands out as a preferable agent with acceptable infectious complication rates.

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