Hüseyin Buğra KARAKAŞ, Engin Denizhan DEMİRKIRAN, Necmettin Aydın MUNGAN, Bülent AKDUMAN

Prostat Biyopsisi Öncesi Profilaktik Seftibuten ve Gentamisin Uygulanan Hastalarda Akut Prostatit Sıklığı

ÖZETAmaç: Profilaktik seftibuten, gentamisin kombinasyonu verilen erkeklerde transrektal prostat biyopsisi sonrası akut prostatitin insidansını ve özelliklerini araştırmayı amaçladık.Gereç ve Yöntemler: Transrektal ultrasonografi (TRUS) eşliğinde prostat biyopsisi yapılan 245 hastanın 2 yıllık bir süre içinde retrospektif verileri incelendi. İşlemden sonra akut prostatit oluşan erkekler araştırıldı. Tüm hastalara biyopsiden 12 ve 2 saat önce başlamak üzere 5 gün boyunca günde bir kez 400 mg ceftibuten verildi; buna ek olarak prosedürden hemen önce, tek doz 160 mg gentamisin ile intramüsküler olarak yapılmıştır. Tüm biyopsiler ayakta tedavi prosedürü olarak gerçekleştirildi.Bulgular: 245 olgunun 2'sinde (% 0,8) akut prostatit gelişti. Genişlemiş spektrum β-laktamaz aktivitesi pozitif olan Escherichia Coli, 1 olguda hem kan hem de idrardan izole edildi. İdrar ve kan kültürlerinde tespit edilen bakteri siprofloksasin, levofloksasin, gentamisin, sefepim, seftriakson ve sefuroksime dirençliydi. Bununla birlikte, diğer olguda kan veya idrardan hiçbir bakteri izole edilmemiştir. Her iki hastada da ilk biyopsi sonrası akut prostatit geliştiği görüldü.Sonuç: Tek doz gentamisin ile kombine profilaktik seftibuten, TRUS kılavuzluğunda prostat biyopsisi sonrası akut bakteriyel prostatitin önlenmesinde etkili görünmektedir. Dünyada kinolon direncinin artması nedeniyle, prostat biyopsisi yapılan erkeklerde seftibuten gibi sefalosporinleri içeren alternatif profilaksi rejimleri düşünülmelidir. Bu konuda daha büyük serili prospektif randomize çalışmalar daha kesin veriler verebilir.

Anahtar Kelimeler:

Akut bakteriyel prostatit, Anitibiyotik profilaksisi, Seftibuten

Acute Prostatitis Incidence in Patients Receiving Prophylactic Ceftibuten and Gentamicin Before Prostate Biopsy

AbstractObjective: We aimed to investigate the incidence and characteristics of acute prostatitis after transrectal prostate biopsy in men whom were given prophylactic ceftibuten combined with gentamicin.Material and Methods: We analyzed the retrospective data from 245 patients who underwent transrectal ultrasound (TRUS) guided prostate biopsy over a 2 year period. Men in which acute prostatitis occured after the procedure were investigated. All patients received 400 mg ceftibuten orally once daily for 5 days, beginning 12 and 2 hours before biopsy; combined with single dose 160 mg gentamicin intramuscularly just before the procedure. All biopsies were performed as outpatient procedures. Results: Of the 245 cases, acute prostatitis developed in 2 (0,8%). Escherichia Coli that was positive for extended spectrum β-lactamase activity was isolated both from blood and urine in 1 case. The bacteria detected in urine and blood cultures were resistant to ciprofloxacin, levofloxacin, gentamicin, cefepime, ceftriaxone and cefuroxime. However, no bacteria was isolated either from blood or urine in the other case. Both patients had acute prostatitis after the first biopsy. Conclusion: Prophylactic ceftibuten combined with single dose gentamicin seems effective in preventing acute bacterial prostatitis after TRUS-guided prostate biopsy. Due to increasing rate of quinolone resistance among the world, alternative prophylaxis regimens including cephalosporins such as ceftibuten should be considered in men undergoing prostate biopsy. Prospective randomized trials with larger series may give more conclusive data.

Keywords:

Acute bacterial prostatitis Antibiotic prophylaxis, Ceftibuten, Core Needle Biopsy,

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