Editorial Comment
Comment to: “Efficacy and safety of fosfomycin-trometamol in the prophylaxis for transrectal prostate biopsy. Prospective randomized comparison with ciprofloxacin”
Comentario a: «Eficacia y seguridad de fosfomicina-trometamol en la profilaxis de la biopsia transrectal de la próstata: estudio prospectivo aleatorizado comparativo con ciprofloxacino»
A. Jiménez-Pacheco
Servicio de Urología, Hospital Santa Ana, Motril, Granada, Spain
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Bx: biopsy; AS: active surveillance.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Guijarro, V. Hernández, B. López, C. Capitán, E. Pérez-Fernández, E. de la Peña, J.M. de la Morena, C. Llorente" "autores" => array:8 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Guijarro" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Hernández" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "López" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Capitán" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Pérez-Fernández" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "de la Peña" ] 6 => array:2 [ "nombre" => "J.M." "apellidos" => "de la Morena" ] 7 => array:2 [ "nombre" => "C." "apellidos" => "Llorente" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480614003374" "doi" => "10.1016/j.acuro.2014.08.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480614003374?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578615000189?idApp=UINPBA00004N" "url" => "/21735786/0000003900000003/v2_201503280430/S2173578615000189/v2_201503280430/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial Comment</span>" "titulo" => "Comment to: “Efficacy and safety of fosfomycin-trometamol in the prophylaxis for transrectal prostate biopsy. Prospective randomized comparison with ciprofloxacin”" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "137" "paginaFinal" => "138" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "A. Jiménez-Pacheco" "autores" => array:1 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Jiménez-Pacheco" "email" => array:1 [ 0 => "anjipa29@hotmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Urología, Hospital Santa Ana, Motril, Granada, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario a: «Eficacia y seguridad de fosfomicina-trometamol en la profilaxis de la biopsia transrectal de la próstata: estudio prospectivo aleatorizado comparativo con ciprofloxacino»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Although transrectal prostate biopsy is generally considered a safe procedure, an increased risk of infectious complications after the biopsy has been observed in recent years, possibly related to the presence of microorganisms in the intestinal flora of these fluoroquinolone-resistant patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Lista et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> used as antibiotic prophylaxis 3<span class="elsevierStyleHsp" style=""></span>g fosfomycin trometamol in two doses orally (24<span class="elsevierStyleHsp" style=""></span>h before and 24<span class="elsevierStyleHsp" style=""></span>h after the biopsy), and they compared it to 500<span class="elsevierStyleHsp" style=""></span>mg ciprofloxacin orally every 12<span class="elsevierStyleHsp" style=""></span>h for 5 days. These authors found that the presence of complications of any kind related to transrectal biopsy was higher in the group that was administered ciprofloxacin, although this difference was not statistically significant, except for hemospermia.</p><p id="par0015" class="elsevierStylePara elsevierViewall">These results are similar to those of the study carried out by Ongün et al.,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> who compared a single dose of 3<span class="elsevierStyleHsp" style=""></span>g fosfomycin trometamol (the night before the biopsy) to a single dose of 500<span class="elsevierStyleHsp" style=""></span>mg levofloxacin (60<span class="elsevierStyleHsp" style=""></span>min before the biopsy). Although the number of hospitalizations secondary to febrile urinary tract infections was reduced from 3.4% to 0.9% in the group of fosfomycin trometamol, this difference was not statistically significant, the same as among symptomatic and asymptomatic infections.</p><p id="par0020" class="elsevierStylePara elsevierViewall">These results suggest that fosfomycin could become an alternative antibiotic for men undergoing prostate biopsy. However, although fosfomycin reaches high concentrations in urine and the bladder mucosa and it has a sensitivity versus <span class="elsevierStyleItalic">Escherichia coli</span> around 97%, there are few data on its dissemination and concentration capacity in the prostate, unlike fluoroquinolones, which are characterized by their high capacity to penetrate the prostate tissue.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Published prevalence rates of colonization of the intestinal flora with microorganisms resistant to fluoroquinolones in this patient population ranges from 10.6% to 22%. However, most urologists continue using fluoroquinolones empirically as prophylaxis prior to transrectal biopsy. The culture of the rectal swab before the biopsy is a method to isolate and identify microorganisms resistant to fluoroquinolones in the intestinal native flora of these patients. Some studies have suggested that this culture of the rectal swab before biopsy can be useful in selecting suitable antimicrobial agents for the prophylaxis and treatment of infectious complications associated with the biopsy, besides involving health economic savings.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It is clear that although antibiotic prophylaxis is recommended in transrectal prostate biopsy, there are no specific recommendations or based on data identifying the superiority of any particular regimen (dose, duration, type of antibiotic, etc.). In countries like Spain, where the percentage of resistance to fluoroquinolones exceeds 20%, good practice would be to perform rectal swabs in all patients undergoing prostate biopsy, as it is a fast and economical method. Only in those individuals in whom strains of <span class="elsevierStyleItalic">E. coli</span> resistant to quinolones were isolated, we would use fosfomycin or any other antimicrobial depending on the results of the antibiogram. Thus, antibiotics such as fosfomycin could be saved, preventing indiscriminate use and the consequent appearance of future resistance.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jiménez-Pacheco A. Comentario a: «Eficacia y seguridad de fosfomicina-trometamol en la profilaxis de la biopsia transrectal de la próstata: estudio prospectivo aleatorizado comparativo con ciprofloxacino». Actas Urol Esp. 2015;39:137–138.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eficacia y seguridad de fosfomicina-trometamol en la profilaxis de la biopsia transrectal de la próstata: estudio prospectivo aleatorizado comparativo con ciprofloxacino" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Lista" 1 => "C. Redondo" 2 => "E. Meilán" 3 => "A. García-Tello" 4 => "F. Ramón de Fata" 5 => "J.C. Angulo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2014.01.002" "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2014" "volumen" => "38" "paginaInicial" => "391" "paginaFinal" => "396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24775812" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effectiveness of single-dose fosfomycin as antimicrobial prophylaxis for patients undergoing transrectal ultrasound-guided biopsy of the prostate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Ongün" 1 => "G. Aslan" 2 => "V. Avkan-Oguz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000342370" "Revista" => array:6 [ "tituloSerie" => "Urol Int" "fecha" => "2012" "volumen" => "89" "paginaInicial" => "439" "paginaFinal" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23006631" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.K. Taylor" 1 => "T.R. Zembower" 2 => "R.B. Nadler" 3 => "M.H. Scheetz" 4 => "J.P. Cashy" 5 => "D. Bowen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2011.11.115" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2012" "volumen" => "187" "paginaInicial" => "1275" "paginaFinal" => "1279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22341272" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000003900000003/v2_201503280430/S2173578615000177/v2_201503280430/en/main.assets" "Apartado" => array:4 [ "identificador" => "6293" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003900000003/v2_201503280430/S2173578615000177/v2_201503280430/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578615000177?idApp=UINPBA00004N" ]
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