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

前列腺活检时快速 PCR 指导抗生素治疗

• 批准号: 9168209
• 负责人: Michael Andre Liss
• 金额: $ 10万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9168209
• 关键词: Rapid; PCR; Guide; Antibiotic; Therapy

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.

项目概要/摘要 活检是评估前列腺特异性抗原 (PSA) 升高或 前列腺癌筛查期间的异常检查通常通过直肠进行前列腺活检。 超声引导针活检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，最常见的用于预防感染的抗生素（氟喹诺酮类）已成为 尽管它是一种名为大肠杆菌的特殊菌株，但由于耐药性而效果较差。 大肠杆菌 ST131 引起大多数感染，因为它对氟喹诺酮类药物几乎具有固有的耐药性。 研究中，我们根据医生的判断将男性随机分组接受抗生素强化治疗（除了氟喹诺酮类药物外） 如果他们选择的话）与使用聚合酶链反应 (PCR) 进行快速检测来识别 ST131 大肠杆菌 如果确定，我们会根据之前的研究建议使用额外的抗生素。 已经确定了对特定类型细菌通常耐药性较低的抗生素，我们认为这会。 减少目前的策略，即使用更广谱的抗生素来增强所有患者的能力或使用不良的抗生素 明确的基于风险的策略更有针对性地使用抗生素有助于保持广谱性。 使用直肠培养描述了类似的策略。 然而，在前列腺活检之前，该技术尚未普及，部分原因是后勤问题和 我们预计快速护理测试可能会更容易实施。 跨各种做法，鼓励更有针对性地使用抗生素，同时减少感染 该研究的次要目的是调查临床工作流程和信徒的看法。 之前指导预防的尝试因以下原因而失败。 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问题 将有最大的泌尿外科实践成功机会。