Local Antibiogram Predicts Appropriate Antibiotic Selection for Prostate Biopsy Prophylaxis

Abstract

PurposeWe evaluate our local antibiogram to determine the accuracy of its use in antibiotic augmentation prior to transrectal prostate biopsy (TRPB). Materials and MethodsWe analyzed pre-TRPB rectal swabs from January 2016 to September 2017 at the South Texas Veterans Health Care System (STVHCS). A query was run on pre-procedure rectal swabs positive for fluoroquinolone resistance in men undergoing TRPB during this time. Culture results and antibiotic resistance profiles were recorded and compared to the proportion of antibiotic resistance in the STVHCS 2016 antibiogram. ResultsWe identified 611 patients who underwent pre-TRPB rectal culture, of which 98 were ciprofloxacin resistant E.coli (CRE) isolates. Our cohort demonstrated 80% sensitivity to ciprofloxacin as compared to the STVHCS antibiogram sensitivity of 65% (p<0.001). Gentamicin demonstrated similar sensitivities between the antibiogram and cohort (90% and 88% respectively). There were no statistically significant differences between the STVHCS antibiogram and the sensitivity profiles of our rectal swab cohort as demonstrated in figure 1, except for Ampicillin/Sulbactam, which was 57% in the antibiogram and 32% in our cohort (p=0.019). Of the CRE identified, 4% (4/98) were considered extended spectrum beta-lactamase producers (ESBL). ConclusionsOverall, resistance patterns in CRE isolates from our study population are consistent with the STVHCS antibiogram therefore; a local antibiogram may be utilized in an implementation strategy for targeted antibiotics or augmentation of fluoroquinolone prophylaxis for TRPB.