Login to Access Video or Poster Abstract: MP77-05
Sources of Funding: None

Introduction

Complications following prostate biopsy are rare but can be devastating. The American Urologic Association (AUA) Quality Improvement Summit in 2014 recommended identifying high risk patients and considering augmented antibiotics. We prospectively implemented a biopsy protocol to identify high-risk patients for bleeding or infections and use augmented antibiotics with the objective of reducing complications.

Methods

Overall, 637 consecutive patients from June 1, 2014 to August 30, 2016, who underwent prostate biopsy at our Veterans Affairs hospital were evaluated. The prostate biopsy protocol required the provider to document infectious risk factors including prior UTI, antibiotic exposure, and/or recent biopsy to alert the prescriber to substitute IM ceftriaxone for oral ciprofloxacin in high-risk patients. Patients were also monitored closer for bleeding after the biopsy, especially those driving ≥2 hours. We defined complications as any deviations from normal post-biopsy activities. Comparisons were made between pre/post protocol cohorts, and logistic regression was used to identify risk factors for admissions or complications.

Results

The median age was 67 (IQR 64-69, p=0.4) in both groups (pre n=334, post n=303). 45 patients were deemed high infectious risk with the following patient-reported events: 22 patients with antibiotics for recent UTI, 10 patients with history of complicated UTI/prostatitis, 16 patients with prostate biopsies within 6 months and 3 patients with clean intermittent catheterization or indwelling catheter. Pre-protocol, 98.8% patients received ciprofloxacin empirically; post-protocol, 85.7% received ciprofloxacin and 14.3% received ceftriaxone (p<0.001). _x000D_ _x000D_ There were no deaths in either group. The 30-day complication rates pre- and post-protocol were 16.2% and 8.5% (p=0.001) with infectious complication rates of 1.2% and 1.7% (p=0.74). There was a decrease in 30-day hospitalization rate in the post-protocol group vs. the pre-protocol group (1% vs. 3.6%, p=0.04). On logistic regression, there were reduced odds of 30-day complications (OR 0.48, p=0.004) and 30-day hospitalization (OR 0.27, p=0.04) in the post-protocol group.

Conclusions

A screening protocol for bleeding and infectious risks prior to prostate biopsy provides a more targeted approach for selecting prophylactic antibiotics and closer monitoring post-biopsy for bleeding. Rates of infection overall were quite low. Our results suggest that the protocol has a favorable impact on complication and hospitalization rates.

Funding

None