Rapid PCR to Guide Antibiotic Therapy at the Time of Prostate Biopsy

项目摘要/摘要 前列腺活检是评估前列腺特异性抗原(PSA)升高或 前列腺癌筛查中的前列腺检查异常。活检通常是通过直肠进行的 超声波，以便引导针吸活组织检查进入前列腺的指定区域。基于办公室的程序 相对安全，是工业化国家最常见的泌尿外科手术之一。 然而，用于预防感染的最常见的抗生素类别(氟喹诺酮)已成为 尽管这是护理的标准，但由于耐药性，效果较差。一种特殊的细菌菌株命名为E. 由于其对氟喹诺酮类药物几乎固有的耐药性，导致大多数感染是由ST131引起的。在这 研究表明，我们根据医生的判断，随机对男性进行抗生素强化治疗(除氟喹诺酮外 如果他们愿意的话)，而不是使用聚合酶链式反应(PCR)在 活检时间。如果被发现，我们会建议根据之前的研究使用另一种抗生素 已经确定了对特定类型的细菌通常抗药性较低的抗生素。我们觉得这会 减少目前的策略，即要么增加所有患者的广谱抗生素，要么使用不良反应- 定义了基于风险的战略。更有针对性地使用抗生素可能有助于保持广谱 抗生素，并减少未来的抗生素耐药性。使用直肠培养也描述了类似的策略。 然而，这项技术尚未普及，部分原因是后勤问题和 医患不便。我们预计，快速的护理点检测可能更容易实施 跨越各种做法，并鼓励更有针对性地使用抗生素，同时也减少感染 前列腺活检。这项研究的次要目标是调查临床工作流程和临床医生的看法 和患者对这项新技术的看法。之前指导预防的尝试都失败了，原因是 实施；因此，我们的研究将使我们能够深入了解如何最好地解决抗生素选择 将有最大的机会成功的泌尿外科实践。

Project Summary/Abstract A prostate biopsy is the most common procedure to evaluate an elevated prostate specific antigen (PSA) or abnormal prostate exam during prostate cancer screening. The biopsy is typically performed with a rectal ultrasound in order to guide needle biopsies into designated areas of the prostate. The office-based procedure is relatively safe and is one of the most common urologic procedures performed in industrialized countries. However, the most common class of antibiotics used to protect from infection (fluoroquinolone) has become less effective due to resistance, despite it being the standard of care. A particular strain of bacteria named E. coli ST131 causes the majority of infections due to it nearly inherent resistance to fluoroquinolones. In this study, we randomize men to antibiotic augmentation by physician’s discretion (in addition to a fluoroquinolone if they chose) versus a rapid test to identify the ST131 E. coli using polymerase chain reaction (PCR) at the time of biopsy. If identified, we would advise the use of an additional antibiotic based on previous studies that have identified antibiotics that typically are less resistant for that particular type of bacteria. We feel this would reduce the current strategy of either augmenting all patients with more broad-spectrum antibiotics or using ill- defined risk based strategy. The more targeted use of antibiotics could help preserve broad-spectrum antibiotics and reduce future antibiotic resistance. A similar strategy has been described using rectal culture prior to prostate biopsy; however, this technique has not been popularized in part due to logistical issues and physician-patient inconvenience. We project that a rapid point of care test may be more easily implemented across various practices and encourage more targeted use of antibiotics, while also reducing infections of the prostate biopsy. Secondary aims of the study are to investigate the clinic workflow and perceptions of clinicians and patients regarding the new technology. Previous attempts to guide prophylaxis have failed due to implementation; therefore, our study will allow us to gain insight into how best to address antibiotic choices that will have the best chance of success urologic practice.