MP13-14 ANTIBIOPROPHYLAXIS FOR TRANSRECTAL ULTRASOUND-GUIDED PROSTATE NEEDLE BIOPSY: IS PREVENTION OF POST-PROCEDURAL URINARY SEPSIS IMPROVED WITH THE NOVEL COMBINATION OF CIPROFLOXACIN AND FOSFOMYCIN?
Bibliographic record
Abstract
You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP13)1 Apr 2019MP13-14 ANTIBIOPROPHYLAXIS FOR TRANSRECTAL ULTRASOUND-GUIDED PROSTATE NEEDLE BIOPSY: IS PREVENTION OF POST-PROCEDURAL URINARY SEPSIS IMPROVED WITH THE NOVEL COMBINATION OF CIPROFLOXACIN AND FOSFOMYCIN? Alexandre Morin*, Marco Bergevin, and Steven P Lapointe Alexandre Morin*Alexandre Morin* More articles by this author , Marco BergevinMarco Bergevin More articles by this author , and Steven P LapointeSteven P Lapointe More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555227.90990.5aAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Fluoroquinolones are recommended as first line antibioprophylaxis (ATBPx) for transrectal ultrasound-guided prostate needle biopsy (PNB). Recent studies report rising rates of post-PNB infections associated with emergent fluoroquinolone resistant E. coli, urging re-evalutation of ATBPx. The objective of this study was to compare rates of post-PNB sepsis associated with 2 oral regimens of ATBPx: a single dose of ciprofloxacin 500 mg (CIP) vs single dose of ciprofloxacin 500 mg and fosfomycin 3 g combination (CIP/FOS). METHODS: We performed a retrospective, pre-post intervention study on all patients who underwent PNB in 2 Canadian hospitals from January 2012 to December 2015. ATBPx was changed from CIP to CIP/FOS in December 2013. ATBPx was administered two hours prior to PNB, along with a sodium phosphate enema. Patient charts were reviewed for hospital visits, microbiologic results, and 14 recognized risk factors for post-PNB infectious complications. The primary outcome was urosepsis within 1 month of PNB. Sepsis rates, according to ATBPx regimens, were analyzed using log-binomial regression considering the propensity scores weights of collected risk factor data. RESULTS: We reviewed charts of 2,287 patients, including 1090 who received CIP alone and 1197 who received CIP/FOS. Urosepsis incidence with CIP alone was 1.1% (12/1090) and fell to 0.2% (2/1197) with CIP/FOS. Our analysis indicates that CIP/FOS significantly decreased the risk of sepsis compared to CIP alone (aRR = 0.16; p = 0.021). The pathogen was E. coli in 12/14 cases, with 7 CIP resistant strains. Most E. coli (11/12) were from CIP alone group. We observed 7 cases of E. coli bacteremia, with 5/7 blood cultures showing CIP resistant strains. One case of B. fragilis septicemia occurred in the CIP/FOS group. No cases of C. difficile diarrhea were identified within the 3 months post-PNB. CONCLUSIONS: The use of CIP/FOS prophylaxis in PNB significantly lowered our rates of post-procedural sepsis. Conveniently, this regimen is oral and obviates the need for rectal swab screening. Further prospective studies should be performed before widespread use of this antibioprophylaxis regimen. Source of Funding: AbbVie unrestricted educational grant Sherbrooke, Canada; Nathalie Rivest, Laval, Canada; Mont-Royal, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e182-e183 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre Morin* More articles by this author Marco Bergevin More articles by this author Steven P Lapointe More articles by this author Expand All Advertisement PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.014 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".