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

项目总结/摘要 前列腺活检是评估前列腺特异性抗原（PSA）升高或 前列腺癌筛查期间前列腺检查异常。活检通常是用直肠活检进行的。 超声引导穿刺活检进入前列腺的指定区域。基于办公室的程序 是相对安全的，并且是在工业化国家进行的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（氟喹诺酮）已成为 由于耐药性而效果较差，尽管这是护理标准。一种名为E. 大肠杆菌ST 131由于其几乎固有的对氟喹诺酮类的耐药性而引起大多数感染。在这 在这项研究中，我们根据医生的判断将男性随机分为抗生素强化组（除氟喹诺酮外 如果他们选择）与快速测试，以确定ST 131 E。在大肠杆菌中使用聚合酶链反应（PCR）， 活检时间。如果确定，我们将建议使用基于先前研究的额外抗生素， 已经确定了对这种特定类型的细菌抵抗力较低的抗生素。我们认为这将 减少目前的策略，要么增加所有患者更多的广谱抗生素或使用不良的， 基于风险的战略。更有针对性地使用抗生素可以帮助保护广谱抗生素。 抗生素和减少未来的抗生素耐药性。类似的策略已经被描述为使用直肠培养 在前列腺活检之前;然而，这种技术尚未普及，部分原因是后勤问题， 医生和病人之间的不便我们预计，快速的护理点测试可能更容易实施 在各种实践中，并鼓励更有针对性地使用抗生素，同时也减少了 前列腺活检本研究的次要目的是调查临床工作流程和临床医生的看法 患者对新技术的看法。以前指导预防的尝试失败，原因是 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， 将有最大的成功机会泌尿科的做法。

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.