Login to Access Video or Poster Abstract: MP11-14
Sources of Funding: None

Introduction

Prophylactic antibiotics are recommended in the American Urological Association (AUA) guidelines to reduce infectious complications following transrectal prostate biopsy (TRPB). Evidence for fluoroquinolone (FQ) prophylaxis is strong but high rates of FQ resistance worldwide have led to increased incidence of post-biopsy infections. Targeted antimicrobial prophylaxis based on rectal swab and culture can decrease rates of post-biopsy infections. To our knowledge, this will be the first study in North America to comprehensively analyze the cost utility of rectal swabs as a tool to reduce infectious complications after prostate biopsy.

Methods

A decision analytic model was prepared to compare costs of TRPB infectious complications (no infection, outpatient prostatitis, and inpatient prostatitis) among patients who had standard three-day ciprofloxacin prophylaxis compared to targeted three-day antimicrobials. Rates of infection were based on a recent large meta-analysis and rates of resistance were based on local institutional data. Costs were calculated based on hospital-derived data regarding average cost of inpatient stay, regional costs of common oral and intravenous antibiotics, and lab estimates of labour and material costs for investigations. These were all based on Canadian dollars (CAD). Quality-adjusted life years (QALYs) were calculated based on standard utility values for healthy middle-aged men, outpatient urinary tract infections (UTIs), and inpatient UTIs (as a surrogate for prostatitis). Several presumptions were made to produce a typical index patient of a man fifty to seventy years of age who is otherwise healthy and has no known multi-drug resistant organisms.

Results

Culture-guided prophylaxis resulted in reduced cost compared to standard prophylaxis ($77 CAD versus $143 CAD) and reduction in quality-adjusted life years (QALYs) by 0.00051. Increasing the cost of performing rectal swabs from $31 CAD to 95CAD causes the two arms to equalize at $141 CAD. Utilizing standard prophylaxis, compared to targeted, would result in an $83 CAD increase in cost to the patient.

Conclusions

The use of rectal swabs prior to prostate biopsy for targeted prophylactic antimicrobial therapy is both less costly and confers a greater quality of life compared to standard ciprofloxacin prophylaxis.

Funding

None