Login to Access Video or Poster Abstract: MP43-06
Sources of Funding: none

Introduction

To investigate whether targeted antibiotic prophylaxis (TAP) using rectal swab cultures (RSC) prior to transrectal ultrasound guided prostate (TRUSP) biopsy has an effect on hospitalization for infectious complications related to TRUSP biopsies.

Methods

We evaluated a cohort of men between 1995 and 2016 with prostate cancer on active surveillance (AS) receiving annual surveillance TRUSP biopsies. Routine RSC have been used to identify men with fluoroquinolone resistant (FQ-R) organisms since October 2012. Patients with FQ-R bacteria received TAP while patients without FQ-R bacteria received standard oral ciprofloxacin prophylaxis. We identified men with infectious complications requiring hospitalization for suspected post-biopsy sepsis via mailed questionnaires. The key questions identified patients hospitalized after a TRUSP biopsy for infection, and the date of admission. The incidence of infections requiring hospitalization was compared for patients receiving TAP vs. standard prophylaxis prior to TRUSP biopsy. The impact of FQ-R on hospitalization was assessed.

Results

Of 1167 men currently on the AS program at our institution, 825 returned the questionnaire and were included in the analysis. For these men, there were a total of 3361 biopsy events. A total of 7 (0.79%) of 886 biopsies preceded by RSC resulted in infectious complications leading to hospitalization compared to 24 (0.97%) of 2475 biopsies without RSC (odds ratio (OR) 0.81 (0.35-1.89),p=0.63). Among the 886 RSCs performed, FQ-R organisms were identified in 194 (21.9%). Six out of 194 (3.1%) biopsies with swabs positive for FQ-R organisms resulted in hospital admission while 1 out of 692 (0.14%) biopsies with swabs negative for FQ-R resulted in admission (OR 22.1 (2.6-184.3),p<0.01, Figure). Age, race, and PSA at diagnosis did not significantly differ while smaller prostate volume at diagnosis was significantly associated with hospitalization (40.4 vs. 50.3 grams,p=0.03).

Conclusions

Compared to empirical ciprofloxacin prophylaxis, TAP using RSC before undergoing TRUSP biopsy was associated with a nonsignificant decrease in rate of hospitalization for suspected post-biopsy sepsis. A RSC positive for FQ-R organisms and smaller prostate volume at diagnosis were associated with a higher rate of hospitalization.

Funding

none