Tarık YONGUÇ, İbrahim Halil BOZKURT, Salih POLAT, Özgü AYDOĞDU, Volkan ŞEN, Tansu DEĞİRMENCİ, Serkan YARIMOĞLU, Süleyman MİNARECİ

Prostat biyopsisi sonrası gelişen sepsis gerçekten korkulan ve mortalitesi yüksek bir komplikasyon mudur?

Amaç: Günümüzde prostat spesifik antijen PSA kullanımının yaygınlaşması ile prostat kanseri tanısında transrektal ultrason eşliğinde prostat iğne biyopsisi TRUSİB yapılma sıklığı artmıştır. İşlemin getirdiği komplikasyonlar arasında en mortal olanı ise şüphesiz ürosepsis komplikasyonudur. Biz bu çalışmamızda TRUSİB sonrası gelişen sepsis sıklığını,sonuçlarını ve olguları etken patojen ve antibiyotik dirençi açısından değerlendirmeyi amaçladık.Hasta ve Yöntem: 2010-2014 yılları arasında prostat ca şüphesiyle TRUSİB yapılan 2350 hasta geriye dönük tarandı. Tüm hastalara işlemden bir gün önce iki doz oral 500mg ciprofloksasin ve işlemden 6 saat önce uygulanmak üzere rektal lavman verilmiş olup lokal anestezi olarak trans rektal %2 lik 20cc lidokain enjeksiyonu uygulanmıştır. Biyopsiler 18 gauge ince iğne ve otomatik tabanca kullanılarak transrektal ultrason eşliğinde alınmıştır.Bulgular: Toplam 2224 hasta çalışmaya dahil edildi. 16 ürosepsis vakasına rastlandı. Hastların 3 üç ’ünde kan kültüründe, 5 beş ’inde idrar kültüründe üreme olduğu görüldü. Enfeksiyon hastalıkları uzmanı önerisi ile Tablo 1’de belirtilen geniş spektrumlı antibiyotikler ile tedavi uygulanmış olup hastaların ortalama hospitalizasyon süresi 7-10 gün idi. Hiç bir hastada üretral kataterizasyon gereksinimi olmadı. İdrar kültüründe veya kan kültüründe üremesi olan tüm hastalarda ciprofloksasin direnci tespit edildi.Sonuç: TRUSİB sonrası bizim kliniğimizde sepsis oranı %0,7 olarak tespit edildi ve mortalite ile sonuçlanan hasta yoktu. Bu sonuçlara göre TRUSİB’nde ciprofloksasin ile profilaksi oldukça etkin ve güvenilirdir. En korkulan komplikasyon olan ürosepsis oldukça nadir görülmekte ve uygun antibiyotik ile tedavi edilebilmektedir

Anahtar Kelimeler:

Prostat kanseri, prostat biyopsisi, sepsis, antibiyotik profilaksisi

Sepsis complications following prostate biopsy, is it really feared and high mortality complication?

Objective: Transrectal ultrasound-guided prostate needle biopsy TRUSPB frequency is increased due to wide spread use of prostate specific antigen psa for diagnosis of prostate cancer. Without doubt urosepsis complications is the most lethal complication. In this study we evaluated incidence and results of sepsis and cases of the causative pathogen with antibiotic resistance after transrectal ultrasound guided prostate needle biopsy. Patients and Methods: Between 2010 and 2014 years 2350 patients undergoing biopsy for suspected prostate cancer were screened retrospectively. All patients recieved two doses oral 500mg ciprofloxacin one day before the biopsy and rectal enema were given 6 hours pre-biopsy. Transrectal 2% lidocaine was injected for local anesthesia. Biopsies were performed using 18 gauge automated spring-loaded biopsy gun with transrectal ultrasound guided.Results: Total 2224 patients were included in the study. 16 cases of sepsis was observed. Blood culture was positive in three of the patients and urine culture was positive in five of the patients. Patients was treated by infection specialist with broad-spectrum antibiotics listed in Table 1. The average hospitalization time was 7-10 days. Ciprofloxacin resistance was detected in all patient that have positive blood and/or urine culture. Conclusion: In our clinic, the frequency of sepsis was found to be %0,7 and there was no mortality. According to these results, ciprofloxacin prophylaxis is safe and effective in TRUSPB. Urosepsis which is the most feared complication is rarely seen and it can be treated with appropriate antibiotics

Keywords:

Prostate cancer, prostate biopsy, sepsis, antibiotic prophylaxis,

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