Profilaxis antibiótica «dirigida» por cultivos rectales antes de la biopsia prostática transrectal: reducción de complicaciones infecciosas y costes de atención sanitaria

espanolIntroduccion La biopsia prostatica transrectal ecograficamente dirigida (BPTE) se asocia a complicaciones infecciosas (CI). Las CI estan relacionadas con un incremento de la prevalencia de bacterias ciprofloxacino-resistentes (BCR) en la flora rectal. Estudiamos las CI ocurridas en 2 grupos. Grupo de profilaxis antibiotica «dirigida» (GPD) vs. grupo de profilaxis empirica (GPE). Evaluamos el impacto economico que supone la profilaxis antibiotica «dirigida» (PD). Material y metodos El GPD se estudio prospectivamente (junio 2013-julio 2014). Se recogieron cultivos rectales (CR) antes de BPTE y se sembraron en medios selectivos con ciprofloxacino para determinar la presencia de BCR. Los pacientes con bacterias sensibles recibieron ciprofloxacino. Pacientes con bacterias resistentes recibieron PD segun antibiograma del CR. El GPE se estudio retrospectivamente (enero 2011-junio 2009). El CR no se realizo y todos los pacientes recibieron ciprofloxacino como profilaxis. Las CI ocurridas en ambos grupos se registraron en un periodo no superior a 30 dias despues de BPTE (historia clinica electronica). Resultados Trescientos pacientes fueron sometidos a BPTE, 145 recibieron PD y 155 PE. En el GPD, 23 pacientes (15,86%) presentaron BCR en CR. Solo un paciente (0,7%) experimento ITU. En el GPE, 26 pacientes (16,8%) experimentaron multiples CI (incluidas 2 sepsis) (p Conclusiones La PD se asocio a un notable descenso de la incidencia de CI causadas por BCR y redujo los costos de atencion sanitaria. EnglishBackground Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP. Material and methods The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). Results Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P Conclusions GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs.