MP16-13 RECTAL SWAB CULTURE-DIRECTED ANTIMICROBIAL PROPHYLAXIS FOR PROSTATE BIOPSY IS ASSOCIATED WITH A LOWER RISK OF INFECTIOUS COMPLICATIONS

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2014MP16-13 RECTAL SWAB CULTURE-DIRECTED ANTIMICROBIAL PROPHYLAXIS FOR PROSTATE BIOPSY IS ASSOCIATED WITH A LOWER RISK OF INFECTIOUS COMPLICATIONS Jessica Dai, Kathleen Hwang, Leonard Mermel, Gyan Pareek, Stephen Schiff, Dragan Golijanin, and Joseph Renzulli Jessica DaiJessica Dai More articles by this author , Kathleen HwangKathleen Hwang More articles by this author , Leonard MermelLeonard Mermel More articles by this author , Gyan PareekGyan Pareek More articles by this author , Stephen SchiffStephen Schiff More articles by this author , Dragan GolijaninDragan Golijanin More articles by this author , and Joseph RenzulliJoseph Renzulli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.586AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of rectal swab cultures to guide antimicrobial prophylaxis for transrectal ultrasound (TRUS)-guided prostate biopsy has been suggested as a way to reduce infectious complications from antibiotic-resistant microorganisms. We assessed the incidence of fluoroquinolone resistance in men undergoing prostate biopsy and evaluated the effect of culture-directed prophylaxis on the risk of infectious complications after prostate biopsy. METHODS All men who received prostate biopsies 2/1/13 – 10/31/13 at our institution were included in an IRB approved retrospective cohort study. At the discretion of the attending physician, patients received either a pre-procedural rectal swab and culture to guide antimicrobial prophylaxis, or routine prophylaxis with a fluoroquinolone antibiotic. Basic patient demographic and clinical information were collected, as well as data on any infectious complications within 30 days of biopsy. Fisher’s exact test and Welch’s t-test were used for statistical analysis. Confounding variables were controlled for with a multivariate logistic regression model. RESULTS 347 patients were included in the study. Of these, 205 patients received a pre-procedure rectal swab culture and 142 did not. Average patient age was 62.6 and 64.4 years, respectively (p=0.04). There was no difference in mean PSA value (p=0.30) or age-adjusted Charlson comorbidity score (p=0.10) between the two groups. 13.1% of rectal cultures demonstrated fluoroquinolone-resistant microorganisms. Infectious complications occurred in 0.9% of the rectal swab group and 2.9% of the control group (p=0.16), which included hospital admissions for bacteremia, pyelonephritis, sepsis, or septic shock. Rectal swab culture-directed antibiotics were associated with a decreased risk for post-biopsy infection (RR 0.17, 95% CI 0.02-1.53). A multivariate logistic regression model demonstrated a decreased risk of infection if a rectal swab culture was done (p=0.11). CONCLUSIONS The incidence of fluoroquinolone resistance is relatively high in our patient population. Overall, infection rates after prostate biopsy are low, with a non-significant reduction in incidence of post-biopsy infection for patients receiving rectal swab-directed antimicrobial prophylaxis. Though not statistically significant, these differences remain clinically significant, given the severity of observed infectious complications. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e158 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jessica Dai More articles by this author Kathleen Hwang More articles by this author Leonard Mermel More articles by this author Gyan Pareek More articles by this author Stephen Schiff More articles by this author Dragan Golijanin More articles by this author Joseph Renzulli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...