Selective transperineal prostate biopsy for fluoroquinolone-resistance patients reduces sepsis and cost

Background:Urosepsis is a recognized complication of transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Pre-biopsy rectal swabs have been used to identify patients with microorganisms in the rectal flora resistant to the conventionally used empirical prophylaxis. The transperineal route of biopsy (TP-Bx) has a lower complication risk but comes at an increased cost.Materials and methods:Retrospective cohort study including patients undergoing prostate biopsies between October/2015 and April/2018. The intervention cohort, a rectal swab was performed, the result of which dictated the biopsy route; TRUS-Bx against TP-Bx. TP-Bx for patients with fluoroquinolone resistance or extended-spectrum β-lactamase. The control cohort underwent TRUS without a rectal swab receiving empirical antibiotics—oral ciprofloxacin and intravenous gentamicin.Results:Total 1000 patients were included in which 500 underwent a swab, 14 (2.8%) developed post-TRUS biopsy infective complications with 3 having positive bacteremia (0.6%); 500 had no swab, 47 (9.4%) developed post-TRUS biopsy infective complications with 22 (4.4%, p < 0.05) having positive bacteremia. Three patients (0.6%) of patients who underwent swab developed urinary tract infection symptoms whilst 12 (2.4%) had urinary tract infection in the control group. In those patients that underwent a swab, 14 required hospitalization with mean length of stay of 2.5 days versus 43 patients of the control with 3.6 days. Cost analysis concluded savings of this strategy was £18,711.Conclusions:We have demonstrated a protocol that reserves template biopsies for higher risk patients and can significantly reduce sepsis and other infectious complication rates whilst also proving to be a cost-efficient strategy. We recommend that units not utilizing rectal swabs to uncover the fluoroquinolone resistance rate by introducing them. We advocate units that already utilize rectal swabs, to introduce transperineal biopsy for their higher risk patients.     

The Canadian National Calibration Reference Centre for In-Vivo Monitoring: thyroid monitoring. Part I: The national inter-comparison programme

This article is the first part of a five-part series covering various aspects of occupational thyroid monitoring. The Canadian National Calibration Reference Centre for In-Vivo Monitoring conducts a thyroid inter-comparison programme that now includes more than 100 facilities. The scope of the programme, begun in 1988, has greatly expanded in the last two years following a considerable effort to locate and inform facilities. This article presents the details of the programme, its results, and the lessons learned. Subsequent articles will discuss sources of errors, methodology, instrumental configuration, and counting geometry optimization.     

Characterization of the bisphosphonate recognition site on hydroxyapatite using radioligand binding techniques with [14C]citric acid

Summary The present studies characterize the binding of [¹⁴C]citric acid to synthetic hydroxyapatite (HA) crystals. [¹⁴C]Citric acid specifically bound to HA and was dependent upon the concentration of HA in the assay. The binding of [¹⁴C]citric acid to HA reached equilibrium within 20 min and remained stable for at least 90 min. Dissociation of bound [¹⁴C]citric acid was biphasic in nature since both rapid and more slowly reversible binding components were detected. Saturation experiments also indicated that [¹⁴C]citric acid labeled two recognition sites with different affinity (Kd_H=42 nM and Kd_L=24,000 nM) and density (Bmax_H=161 fmol/g HA and Bmax_L=8.8 pmol/g HA). Ligand competition experiments revealed that compounds that are known to readily bind bone (e.g., sodium pyrophosphate, methylene diphosphonic acid, etidronate) potently inhibited the binding of [¹⁴C]citric acid to HA, whereas compounds known to have poorer affinity for bone (e.g., oxalic acid and GABA) did not. Computer analysis of these inhibition curves revealed specific ligand interactions at two different affinity recognition sites. The present results indicate that [¹⁴C]citric acid binds discrete sites on synthetic HA in a fashion consistent with a specific labeling of the bisphosphonate recognition site. Analysis of the binding of [¹⁴C]citric acid to HA provides a useful method to further explore the structure activity relationships of novel compounds that have binding affinity for bone.