Initial Antibiotic Selection of Patients Presenting with Infection after Transrectal Prostate Biopsy Leading to a Quality Improvement Initiative

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Background: The incidence of infection associated with transrectal prostate biopsy has been increasing largely due to fluoroquinolone resistance (FQR). Purpose: To identify the antibiotic prescribing patterns employed when men seek medical professionals due to infectious complications of prostate biopsy, and employ a quality improvement initiative to improve antibiotic selection. Methods: A retrospective review determined the percentage of patients who presented to the emergency department (ED) after TRUS biopsy, and whether they were given appropriate antibiotic therapy. Prospective quality improvement was initiated by obtaining cultures via rectal swab at the time of transrectal biopsy in order to allow culture results and fluoroquinolone sensitivities to be available in the electronic medical record. The provider to guide antibiotic selection if the patient returned with infection symptoms could utilize the data. Findings: From 10/2009 to 6/2014, 0.5% (9/1724) of patients who underwent TRUS prostate biopsy returned to the ED with infection. Seven patients had complete data and 4 (0.57%) were given appropriate initial antibiotic treatment. To improve antibiotic selection, the 119 men who underwent rectal swab culture prior to biopsy 19.3% (23/119) showed FQR on rectal culture. 4% (5/119) were hospitalized with infection, demonstrating a significant increase in infection incidence from retrospective chart review (0.5% to 4%, p = 0.0013). Of these 5 men, 60% (3/5) had FQR on rectal culture. Conclusions: Rectal culture at the time of biopsy may lead to faster recognition of resistant bacteria when presented with prostate biopsy infection.