Login to Access Video or Poster Abstract: MP11-12
Sources of Funding: State of Illinois Excellence in Academic Medicine (EAM) grant funded this project: STU00059558 EAM-237.

Introduction

We evaluated the effectiveness of targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound guided prostate biopsy (TRUSP).

Methods

A prospective, non-randomized cohort study evaluated targeted prophylaxis to determine the rate of post-biopsy infectious complications. Rectal swab cultures plated on selective media identified ciprofloxacin-resistant and-susceptible gram-negative bacteria (CR-GNB and CS-GNB). Patients with CS-GNB received ciprofloxacin while those with CR-GNB received directed prophylaxis. Infectious complications were defined clinically and microbiologically within 30 days after TRUSP.

Results

Between November 1, 2012 and March 31, 2015, 510 men completed the study; 430 (84.3%) harbored CS-GNB, 80 (15.7%) CR-GNB and 76 (95%) CR-GNB were Escherichia coli. 484 (94.9%) completed the study per protocol, while 26 (5.1%) who received dual prophylaxis were evaluated in a separate intention-to-treat analysis. Of the 484, 475 (98.1%) had no infections, while 9 (1.9%) experienced clinical infections and 6 (1.2%) were culture-proven (CP). The infections included uncomplicated UTIs n=5 (1.0 %), 4 CP (0.8%); complicated UTIs n=1 (0.2%); and urosepsis, n=3 (0.6 %), 1 CP (0.2%). The 5 patients with uncomplicated UTIs were managed as outpatients, whereas the 4 with complicated UTIs or sepsis were admitted to the hospital for a mean of 2.6 days. All recovered without sequelae. No drug-related adverse events occurred.

Conclusions

Targeted antimicrobial prophylaxis achieved a low rate of infectious complications, limited morbidity and no sustained sequelae. These results were based on individual rectal flora cultures, suggesting that similar results can be obtained in a variety of patients, settings and over time.

Funding

State of Illinois Excellence in Academic Medicine (EAM) grant funded this project: STU00059558 EAM-237.