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| ID | Type | Description | Link |
|---|---|---|---|
| EAM-237 | Other Identifier | Excellence in Academic Medicine |
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This study is being conducted in men scheduled to undergo transrectal ultrasound-guided prostate biopsy (TRUSP). Traditionally prior to prostate biopsy, an antibiotic, ciprofloxacin, has been given to men to prevent biopsy-related infections. In recent years as ciprofloxacin resistance has increased in the community, more and more men are becoming infected with ciprofloxacin-resistant bacteria after prostate biopsy. This study is being done to determine if obtaining rectal swab cultures and choosing antibiotics based on these culture results will result in fewer infectious complications than giving all men ciprofloxacin.
The investigators will compare 2 groups: men whose rectal swabs do not show ciprofloxacin-resistant bacteria will receive ciprofloxacin prior to biopsy, and men whose swabs do show ciprofloxacin-resistant bacteria will receive alternative antibiotics based on their culture results. Our hypothesis is that these 2 groups will have equal numbers of post-biopsy infectious complications and both groups will have fewer infectious complications than a historical group who received empiric ciprofloxacin without the benefit of rectal swab culture results.
This study is a prospective, nonrandomized trial evaluating the efficacy of directed antimicrobial prophylaxis prior to transrectal ultrasound-guided prostate biopsy (TRUSP) compared with ciprofloxacin prophylaxis, the current standard of care. Northwestern University will be the lead site. After signing informed consent, study participants will complete a pre-biopsy questionnaire to record demographics and assess for known risk factors for infection and will have a rectal swab obtained. Patients whose swabs indicate colonization with ciprofloxacin-susceptible gram-negative bacteria (CS-GNB) will receive ciprofloxacin as pre-procedure prophylaxis and those whose swabs indicate colonization with ciprofloxacin-resistant gram-negative bacteria (CR-GNB) will receive pre-procedure antimicrobial prophylaxis based on study protocol.
All patients will be contacted by phone twice after their biopsies, at approximately 7 and 30 days, to detail post-procedure infectious complications including fever, urinary tract infection, bacteremia and sepsis. Subjects who experience infections will have additional information regarding the infectious complications and cost of therapy abstracted from their medical record. The TRUSP results will also be recorded. Bacterial isolates from the rectal swabs will be archived.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cipro-susceptible | Other | Patients with ciprofloxacin-susceptible bacteria on their rectal swab cultures will receive ciprofloxacin, the standard of care, as prophylaxis for their prostate biopsy |
|
| Cipro-resistant | Active Comparator | Patients with ciprofloxacin-resistant bacteria on their rectal swab will receive one of the following drugs:
|
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ciprofloxacin | Drug | 500 mg orally 2 hours before prostate biopsy |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With Post-biopsy Infection. | To measure and compare the rates of infection following TRUSP in subjects with and without CR-GNB. This measure is number of participants with post-biopsy infection. | 30 days post-biopsy |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Anthony J Schaeffer, MD | Northwestern University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Northwestern University Department of Urology | Chicago | Illinois | 60611 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28592230 | Derived | Zembower TR, Maxwell KM, Nadler RB, Cashy J, Scheetz MH, Qi C, Schaeffer AJ. Evaluation of targeted antimicrobial prophylaxis for transrectal ultrasound guided prostate biopsy: a prospective cohort trial. BMC Infect Dis. 2017 Jun 7;17(1):401. doi: 10.1186/s12879-017-2470-1. |
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563 patients consented and of these, 53 were excluded as follows: 16 patients had issues with informed consent, 20 received antimicrobials off protocol, 16 did not undergo TRUSP and 1 was lost to follow up. Thus 510 patients underwent swabs; 430 had CS isolates while 80 had CR isolates. All 510 patients completed the study.
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| ID | Title | Description |
|---|---|---|
| FG000 | Cipro-susceptible | Patients with ciprofloxacin-susceptible bacteria on their rectal swab cultures will receive ciprofloxacin, the standard of care, as prophylaxis for their prostate biopsy Ciprofloxacin: 500 mg orally 2 hours before prostate biopsy |
| FG001 | Cipro-resistant | Patients with ciprofloxacin-resistant bacteria on their rectal swab will receive one of the following drugs:
|
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
Men >/= 18 scheduled for transrectal prostate biopsy who signed consent underwent a rectal swab culture to determine whether they harbored ciprofloxacin-susceptible or -resistant flora. Antimicrobial prophylaxis was chosen based on this result, and patients were followed for 30 days to see if they developed an infection post-procedure.
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| ID | Title | Description |
|---|---|---|
| BG000 | Cipro-susceptible | Patients with ciprofloxacin-susceptible bacteria on their rectal swab cultures will receive ciprofloxacin, the standard of care, as prophylaxis for their prostate biopsy Ciprofloxacin: 500 mg orally 2 hours before prostate biopsy |
| BG001 | Cipro-resistant |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants With Post-biopsy Infection. | To measure and compare the rates of infection following TRUSP in subjects with and without CR-GNB. This measure is number of participants with post-biopsy infection. | Of the 563 patients who signed consent, 53 were excluded; thus, 510 patients participated in the study. Of these 510, 430 harbored ciprofloxacin-susceptible flora and 80 harbored ciprofloxacin-resistant flora. | Posted | Number | participants | 30 days post-biopsy |
|
30 days
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Cipro-susceptible | Patients with ciprofloxacin-susceptible bacteria on their rectal swab cultures will receive ciprofloxacin, the standard of care, as prophylaxis for their prostate biopsy Ciprofloxacin: 500 mg orally 2 hours before prostate biopsy |
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Did not reach recruiting targets due to fewer prostate biopsies being performed than originally estimated in the study period.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Anthony Schaeffer | Northwestern University | 312-908-1615 | ajschaeffer@northwestern.edu |
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| ID | Term |
|---|---|
| D007239 | Infections |
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| ID | Term |
|---|---|
| D002939 | Ciprofloxacin |
| D015662 | Trimethoprim, Sulfamethoxazole Drug Combination |
| D002444 | Cefuroxime |
| D002443 | Ceftriaxone |
| D005839 | Gentamicins |
| D000583 | Amikacin |
| D001398 | Aztreonam |
| D015378 | Imipenem |
| ID | Term |
|---|---|
| D024841 | Fluoroquinolones |
| D042462 | 4-Quinolones |
| D015363 | Quinolones |
| D011804 | Quinolines |
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| trimethoprim-sulfamethoxazole |
| Drug |
1 double strength tablet orally 2 hours before the procedure and again 12 hours later |
|
| cefuroxime | Drug | 500 mg orally 2 hours before the procedure then again 12 hours later |
|
| ceftriaxone | Drug | 500 mg intramuscularly 2 hours before the procedure |
|
| gentamicin | Drug | 2 mg/kg intramuscularly 2 hours before the procedure |
|
| amikacin | Drug | 5 mg/kg intramuscularly 2 hours before the procedure |
|
| aztreonam | Drug | 500 mg intramuscularly 2 hours before the procedure |
|
| imipenem | Drug | 500 mg intramuscularly 2 hours before the procedure |
|
| ceftriaxone | Drug | 2000 mg intravenously 1 hour before the procedure |
|
| gentamicin | Drug | 2 mg/kg intravenously 1 hour before the procedure |
|
| amikacin | Drug | 5 mg/kg intravenously 1 hour before the procedure |
|
| aztreonam | Drug | 2000 mg intravenously 1 hour before the procedure |
|
| imipenem | Drug | 1000 mg intravenously 1 hour before the procedure |
|
Patients with ciprofloxacin-resistant bacteria on their rectal swab will receive one of the following drugs:
|
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Cipro-resistant |
Patients with ciprofloxacin-resistant bacteria on their rectal swab will receive one of the following drugs:
|
|
|
|
| 0 |
| 430 |
| 0 |
| 430 |
| 0 |
| 430 |
| EG001 | Cipro-resistant | Patients with ciprofloxacin-resistant bacteria on their rectal swab will receive one of the following drugs:
| 0 | 80 | 0 | 80 | 0 | 80 |
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| D006574 |
| Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D013420 | Sulfamethoxazole |
| D000096926 | Benzenesulfonamides |
| D013449 | Sulfonamides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D013424 | Sulfanilamides |
| D000814 | Aniline Compounds |
| D000588 | Amines |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D013450 | Sulfones |
| D013457 | Sulfur Compounds |
| D014295 | Trimethoprim |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D004338 | Drug Combinations |
| D004364 | Pharmaceutical Preparations |
| D002511 | Cephalosporins |
| D047090 | beta-Lactams |
| D007769 | Lactams |
| D013843 | Thiazines |
| D002439 | Cefotaxime |
| D002505 | Cephacetrile |
| D000617 | Aminoglycosides |
| D006027 | Glycosides |
| D002241 | Carbohydrates |
| D007612 | Kanamycin |
| D008997 | Monobactams |
| D013845 | Thienamycins |
| D015780 | Carbapenems |