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Comparison of fosfomycin against fluoroquinolones for transrectal prostate biopsy prophylaxis: an individual patient-data meta-analysis

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Abstract

Purpose

To systematically review and meta-analyse available evidence comparing fosfomycin trometamol (FT) to fluoroquinolone (FQ) prophylaxis to prevent transrectal ultrasound-guided prostate biopsy (TRUSPB) related infectious complications.

Methods

Electronic databases were queried for studies comparing FT to FQ-based TRUSPB prophylaxis. Studies were assessed for comparable outcomes and methodological quality (ROBINS-I modification). The primary outcome measure was the relative odds of overall infectious complications following TRUSPB according to FT/FQ treatment, which was evaluated with meta-analysis. Safety and tolerability were also assessed. The relative odds of infections of different severity [Grade 1, bacteriuria and afebrile urinary tract infection (UTI); Grade 2, bacteraemia, febrile UTI, and urosepsis] according to FT/FQ treatment were also estimated.

Results

Five studies, being three prospective randomised trials and two retrospective cohort studies, representing 3112 patients, were included. The relative odds of an infectious complication (OR 0.22, 95% CI 0.09–0.54) or of a more severe (Grade 2) infection (OR 0.13, 95% CI 0.07–0.26) were significantly lower in those receiving FT compared to FQ prophylaxis. A low incidence of medication-related side effects was observed. There were less observed infections due to FQ-resistant pathogens in those receiving FT prophylaxis.

Conclusions

Patients who received FT prophylaxis were less likely than those who received FQ prophylaxis to develop infections overall, as well as severe and resistant infections after TRUSPB. Assessing the performance of FT in other geographic locations or in comparison to targeted prophylaxis based on risk assessment or rectal cultures is desired.

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Funding

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Author information

Authors and Affiliations

  1. Centre for Clinical Research, The University of Queensland, Brisbane, Australia

    Matthew J. Roberts

  2. Faculty of Medicine, The University of Queensland, Brisbane, Australia

    Matthew J. Roberts, Susan Scott & Patrick N. Harris

  3. Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, 4006, Australia

    Matthew J. Roberts

  4. Department of Urology, Sunshine Coast University Hospital, Birtinya, Australia

    Susan Scott

  5. Department of Microbiology, Central Laboratory, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Patrick N. Harris

  6. Department of Urology, Technical University of Munich, Munich, Germany

    Kurt Naber

  7. Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany

    Florian M. E. Wagenlehner

  8. Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar

    Suhail A. R. Doi

Authors
  1. Matthew J. Roberts
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  2. Susan Scott
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  3. Patrick N. Harris
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  4. Kurt Naber
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  5. Florian M. E. Wagenlehner
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  6. Suhail A. R. Doi
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Contributions

MJR: project development, data collection, and manuscript writing. SES: data collection, manuscript editing. PNH: manuscript editing, critical revisions, and guidance. KN: manuscript editing, critical revisions, and guidance. FMEW: manuscript editing, critical revisions, and guidance. SARD: statistical and epidemiological guidance, analysis and manuscript editing.

Corresponding author

Correspondence to Matthew J. Roberts.

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Conflict of interest

K.N. is a paid consultant to Bionorica, DaiichiSankyo, Enteris Biopharma, Leo Pharma, MerLion, OM Pharma, Paratek, Rosen Pharma, and Zambon. F.W. is a paid consultant to Achaogen, Act elion, AstraZeneca, Bionorica, GSK, MSD, Janssen, and Pfizer. All other authors: none to declare.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants within the included manuscripts included in this study.

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Roberts, M.J., Scott, S., Harris, P.N. et al. Comparison of fosfomycin against fluoroquinolones for transrectal prostate biopsy prophylaxis: an individual patient-data meta-analysis. World J Urol 36, 323–330 (2018). https://doi.org/10.1007/s00345-017-2163-9

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  • DOI: https://doi.org/10.1007/s00345-017-2163-9

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