1164 IS THE USE OF EMPIRIC ANTIBIOTICS FOR ELEVATED PROSTATE SPECIFIC ANTIGEN A RISK FACTOR FOR INFECTIOUS COMPLICATIONS AFTER TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY?

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20131164 IS THE USE OF EMPIRIC ANTIBIOTICS FOR ELEVATED PROSTATE SPECIFIC ANTIGEN A RISK FACTOR FOR INFECTIOUS COMPLICATIONS AFTER TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY? Ryan Holland, Laura Gamble, Jill Williams, Rowena Desouza, Alex Gomelsky, and Dennis Venable Ryan HollandRyan Holland Shreveport, LA More articles by this author , Laura GambleLaura Gamble Shreveport, LA More articles by this author , Jill WilliamsJill Williams Shreveport, LA More articles by this author , Rowena DesouzaRowena Desouza Houston, TX More articles by this author , Alex GomelskyAlex Gomelsky Shreveport, LA More articles by this author , and Dennis VenableDennis Venable Shreveport, LA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.801AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An empiric course of antibiotics is often prescribed in the setting of elevated prostate specific antigen (PSA) and many of these men still undergo transrectal ultrasound guided biopsy of the prostate (TRUSBP) to rule out cancer. Infection is a known complication of TRUSBP and rates of post− biopsy infections with resistant bacteria are on the rise. We aim to assess the relationship between the empiric treatment of prostatitis and post−TRUSBP infections to see if men receiving antibiotics to lower the PSA prior to TRUSBP are at higher risk for post−procedure infections. METHODS We conducted a retrospective review of patients who underwent TRUSBP at our institution from August 2006 to July 2011. Medical records were reviewed for a history of empiric antibiotic treatment of at least 1 weekÆs duration within 8 weeks of biopsy. No patient received a pre−biopsy enema. Other factors assessed included age, presence of diabetes, presence of indwelling catheter, number of biopsies, immediate pre− and post−procedure antibiotics, and presence of prostatitis on biopsy results. Infectious complications recorded included documented fever and positive blood and urine cultures. RESULTS A total of 515 TRUSBP were performed in 484 patients (238 received empiric antibiotic therapy, 277 did not). There were 19 (3.7%) infectious complications after TRUSBP, with 12 (5%) occurring in the treatment group and 7 (2.5%) in the untreated group. This was not statistically significant on univariate analysis (RR 1.99; 95% CI 0.80−4.99; p=0.13). Eleven of the 12 infections in the empiric treatment group had received a fluoroquinolone. On multivariate logistic regression analysis, empiric treatment with a fluoroquinolone was the only statistically significant risk factor (OR 3.93; CI 1.36−11.31; p=0.01). All but one of the available urine and blood cultures was positive for fluoroquinolone−resistant E. coli. CONCLUSIONS Although infectious complications were observed in a small subgroup of patients receiving empiric antibiotics for elevated PSA prior to TRUSBP, treatment with a fluoroquinolone was associated with a statistically significant increase in post−biopsy infectious complications. Recent antibiotic exposure should be strongly considered when assessing risk for infectious complications after TRUSBP. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e475 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Holland Shreveport, LA More articles by this author Laura Gamble Shreveport, LA More articles by this author Jill Williams Shreveport, LA More articles by this author Rowena Desouza Houston, TX More articles by this author Alex Gomelsky Shreveport, LA More articles by this author Dennis Venable Shreveport, LA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...