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Aktuelle Urol 2021; 52(04): 356-359
DOI: 10.1055/a-1478-2793
Übersicht

Prostatabiopsie 2021 – Was ist aktuell?

Prostate biopsy 2021: current management
Florian Wagenlehner
1   Justus-Liebig-Universität Gießen, Klinik für Urologie, Kinderurologie und Andrologie, Giessen
,
Gernot Bonkat
2   alta uro AG, Basel, Schweiz
,
Adrian Pilatz
1   Justus-Liebig-Universität Gießen, Klinik für Urologie, Kinderurologie und Andrologie, Giessen
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Zusammenfassung

Infektionskomplikationen nach Prostatabiopsie nehmen zu aufgrund zunehmender Antibiotikaresistenz insbesondere gegenüber Fluorchinolonen. Fluorchinolone sind als perioperative Antibiotikaprophylaxe in Deutschland durch das Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) nicht mehr zugelassen.

Die Leitliniengruppe Urologische Infektionen der Europäischen Gesellschaft für Urologie (EAU) hat kürzlich eine Meta-Analyse in zwei Teilen auf der Basis randomisiert kontrollierter Studien (RCTs) veröffentlicht. Die transperineale Prostatabiopsie ist mit signifikant weniger Infektionskomplikationen assoziiert als die transrektale Biopsie und sollte deswegen bevorzugt werden. Sollte dennoch eine transrektale Biopsie durchgeführt werden, sind eine intrarektale Reinigung mit Povidon-Jod sowie eine antibiotische Prophylaxe ohne Fluorchinolone zu verwenden. Als antibiotische Prophylaxestrategien kommen die zielgerichtete Prophylaxe nach Empfindlichkeitstestung der Enddarmflora, die augmentierte Prophylaxe mit mehreren Antibiotika und die empirische Mono-Prophylaxe mit Nicht-Fluorchinolonen in Frage. Daten aus RCTs liegen hier für Aminoglykoside, 3. Generationscephalosporine und Fosfomycin trometamol vor.

Abstract

Infectious complications following prostate biopsy are on the rise due to an increase in antimicrobial resistance, mainly against fluoroquinolones. The use of fluoroquinolones for perioperative prophylaxis is no longer approved by the national authorities in Germany.

The EAU guideline group on urological infections has recently published a meta-analysis in two parts based on randomised controlled trials (RCTs). Transperineal prostate biopsy is associated with a significantly reduced rate of infectious complications compared with transrectal biopsy and should therefore be preferred. If transrectal biopsy is performed, intrarectal cleaning with povidone-iodine and antibiotic prophylaxis without fluoroquinolones should be chosen. Antibiotic prophylactic strategies include targeted prophylaxis after susceptibility testing of the rectal flora, augmented prophylaxis with multiple antibiotics and empiric mono-prophylaxis with non-fluoroquinolones. Data from RCTs are available for aminoglycosides, third-generation cephalosporins and fosfomycin trometamol.

Schlüsselwörter

Prostatastanzbiopsie - infektiöse Komplikationen - antibiotische Prophylaxe

Keywords

infectious complications - antibiotic prophylaxis - prostate biopsy


Publication History

Article published online:
12 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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