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• W2791567116 abstract "No AccessJournal of UrologyAdult Urology1 Aug 2018Targeted Antimicrobial Prophylaxis Does Not Always Prevent Sepsis after Transrectal Prostate Biopsy Pengbo Jiang, Michael A. Liss, and Richard J. Szabo Pengbo JiangPengbo Jiang Department of Urology, University of California-Irvine, Irvine, California More articles by this author , Michael A. LissMichael A. Liss Department of Urology, University of Texas Health San Antonio, San Antonio, Texas More articles by this author , and Richard J. SzaboRichard J. Szabo Department of Urology, Southern California Kaiser Permanente, Orange County, Irvine, California More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.03.078AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compared the effectiveness of targeted prophylaxis to augmented empirical prophylaxis and single agent empirical prophylaxis to prevent sepsis after transrectal prostate biopsy. Materials and Methods: We retrospectively reviewed the records of transrectal prostate biopsies performed during 3 years at 13 Southern California Kaiser Permanente® departments of urology. Targeted prophylaxis was guided by rectal culture bacterial susceptibility for use of a single prophylactic antibiotic while for empirical prophylaxis 1 antibiotic (single agent empirical prophylaxis) or multiple antibiotics (augmented empirical prophylaxis) were given according to the usual practice of the urologist. Sepsis was the primary outcome analyzed. Results: We reviewed 15,236 transrectal prostate biopsy cases. Targeted prophylaxis, single agent empirical prophylaxis and augmented empirical prophylaxis were administered in 26%, 58% and 16% of cases, respectively. The overall incidence of post-biopsy sepsis was 0.64%. On multivariable analysis there was no significant difference in the rate of post-biopsy sepsis after targeted prophylaxis compared to empirical prophylaxis (single agent and augmented empirical prophylaxis together) (OR 0.86, 95% CI 0.53–1.41, p = 0.561). However, on subanalysis augmented empirical prophylaxis showed a significantly lower incidence of sepsis than single agent empirical or targeted prophylaxis (OR 0.35, 95% CI 0.16–0.76, p = 0.008). Based on blood and urine cultures 38% of the patients with sepsis after transrectal prostate biopsy had been given the correct prophylactic antibiotic prior to biopsy. On multivariable analysis Asian/Pacific Islander or Hispanic/Latino ethnicity was associated with a higher incidence of harboring fluoroquinolone resistant bacteria on rectal swab cultures. Conclusions: This large retrospective study showed that augmented empirical prophylaxis was statistically superior to single agent empirical and targeted prophylaxis. Sepsis developed in a significant number of patients despite being given a prophylactic antibiotic to which the sepsis causing bacteria were sensitive. References 1 : International variation in prostate cancer incidence and mortality rates. Eur Urol2012; 61: 1079. 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Atlanta, Georgia: U.S. Centers for Disease Control and Prevention 2013. Google Scholar 23 : Rectal swab culture-directed antimicrobial prophylaxis for prostate biopsy and risk of postprocedure infection: a cohort study. Urology2015; 85: 8. Google Scholar 24 : Rapid identification of rectal multidrug-resistant escherichia coli before transrectal prostate biopsy. Urology2015; 86: 1200. Google Scholar 25 : Multi-drug resistant E.coli urosepsis in physicians following transrectal ultrasound guided prostate biopsies–three cases including one death. Can J Urol2010; 17: 5135. Google Scholar 26 : Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies. Can Urol Assoc J2010; 4: E12. Google Scholar 27 : Reducing infectious complications following transrectal ultrasound-guided prostate biopsy: a systematic review. Rev Urol2016; 18: 73. Google Scholar 28 : Ultrasound guided, freehand transperineal prostate biopsy: an alternative to the transrectal approach. Urol Pract2016; 3: 134. Link, Google Scholar 29 : Sepsis and 'superbugs': should we favour the transperineal over the transrectal approach for prostate biopsy?. BJU Int2014; 114: 384. Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byCastellani D, Pirola G, Law Y, Gubbiotti M, Giulioni C, Scarcella S, Wroclawski M, Chan E, Chiu P, Teoh J, Gauhar V and Rubilotta E (2021) Infection Rate after Transperineal Prostate Biopsy with and without Prophylactic Antibiotics: Results from a Systematic Review and Meta-Analysis of Comparative StudiesJournal of Urology, VOL. 207, NO. 1, (25-34), Online publication date: 1-Jan-2022.Smith J (2018) This Month in Adult UrologyJournal of Urology, VOL. 200, NO. 2, (215-217), Online publication date: 1-Aug-2018. Volume 200Issue 2August 2018Page: 361-368 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsdrug resistanceantibiotic prophylaxisfluoroquinolonesbiopsyprostatebacterialAcknowledgmentsIngrid Rosenthal developed the clarity report spreadsheets from the HealthConnect database.MetricsAuthor Information Pengbo Jiang Department of Urology, University of California-Irvine, Irvine, California More articles by this author Michael A. Liss Department of Urology, University of Texas Health San Antonio, San Antonio, Texas More articles by this author Richard J. Szabo Department of Urology, Southern California Kaiser Permanente, Orange County, Irvine, California More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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