1439 TARGETED ANTIMICROBIAL PROPHYLAXIS USING RECTAL SWAB (RS) CULTURES IN MEN UNDERGOING TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY (TRUSP) SIGNIFICANTLY REDUCES THE INCIDENCE OF POST PROCEDURE INFECTIOUS COMPLICATIONS AND COST OF CARE

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20111439 TARGETED ANTIMICROBIAL PROPHYLAXIS USING RECTAL SWAB (RS) CULTURES IN MEN UNDERGOING TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY (TRUSP) SIGNIFICANTLY REDUCES THE INCIDENCE OF POST PROCEDURE INFECTIOUS COMPLICATIONS AND COST OF CARE Aisha Taylor, Adam Murphy, John Cashy, Teresa Zembower, Anthony Schaeffer, Robert Nadler, and Elodi Dielubanza Aisha TaylorAisha Taylor Chicago, IL More articles by this author , Adam MurphyAdam Murphy Chicago, IL More articles by this author , John CashyJohn Cashy Chicago, IL More articles by this author , Teresa ZembowerTeresa Zembower Chicago, IL More articles by this author , Anthony SchaefferAnthony Schaeffer Chicago, IL More articles by this author , Robert NadlerRobert Nadler Chicago, IL More articles by this author , and Elodi DielubanzaElodi Dielubanza Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1351AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES About 90% of urologists use fluoroquinolones (FQ) for empiric prophylaxis prior to TRUSP. The increasing prevalence of infections with FQ resistant bacteria in men undergoing TRUSP suggests that empiric FQ prophylaxis may be injudicious. We evaluated the effectiveness of RS culture derived targeted antimicrobial prophylaxis in men undergoing TRUSP. METHODS From July to October 2010 urologists at our institution used targeted vs. standard empiric antimicrobial prophylaxis prior to TRUSP. Standard empiric prophylaxis included a PO dose of ciprofloxacin 2 hours prior to and 12 hours after the procedure. Targeted prophylaxis was based on RS cultures, which identified FQ resistant bacteria plated on MacConkey agar containing ciprofloxacin. Resistance was defined by ciprofloxacin MIC ≥4 μg/ml. Patients with FQ susceptible organisms received ciprofloxacin prophylaxis while those with FQ resistant organisms received antimicrobials based on susceptibilities from the RS cultures. We identified men with infectious complications within 30 days post-TRUSP using the electronic medical record. RESULTS 213 men underwent TRUSP. Forty-three (20.2%) underwent RS while 170 (79.8%) did not. Six (14.0%) of the 43 men who underwent RS grew a FQ resistant organism (1 Klebsiella sp & 5 Escherichia-coli). All 6 men complied with the targeted antimicrobial prophylaxis approach and none suffered an infectious complication post TRUSP. In contrast, 4 (2.3%) of the 170 men undergoing empiric antibiosis without a RS had infectious complications including 1 with prostatitis, 1 cystitis, 1 fever, and 1 with fever, prostatitis, and bacteremia with FQ resistant E. coli. The risk reduction of infectious complications post TRUSP among patients who underwent RS was statistically significant (p<0.01). The cost of a RS culture was $13. The mean cost of managing the infectious complications for all 4 patients in the empiric group was $2153 (range $618–$5271). We calculate the cost of the targeted and empiric therapy approaches per 100 men undergoing TRUSP, including the Medicare costs for IM antimicrobial administration ($23/administration). The cost per 100 TRUS prostate biopsies for the targeted approach is $1323 vs. $5066 for the empiric approach. CONCLUSIONS Targeted antimicrobial prophylaxis significantly reduced the incidence of post-TRUSP infectious complications caused by FQ resistant organisms, and decreased the overall cost of care. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySchaeffer E (2018) Re: Prevalence of Antimicrobial Resistance in Intestinal Flora of Patients Undergoing Prostatic Biopsy: Implications for Prophylaxis and Treatment of Infections After BiopsyJournal of Urology, VOL. 187, NO. 3, (1004-1004), Online publication date: 1-Mar-2012. Volume 185Issue 4SApril 2011Page: e576 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aisha Taylor Chicago, IL More articles by this author Adam Murphy Chicago, IL More articles by this author John Cashy Chicago, IL More articles by this author Teresa Zembower Chicago, IL More articles by this author Anthony Schaeffer Chicago, IL More articles by this author Robert Nadler Chicago, IL More articles by this author Elodi Dielubanza Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...