Login to Access Video or Poster Abstract: MP92-11
Sources of Funding: None

Introduction

Approximately 1 million transrectal ultrasound-guided prostate biopsies are performed each year in the United States alone. The rates of bacterial resistance and sepsis are increasing. Utilization of rectal swab culture to guide antibiotic prophylaxis has been demonstrated to reduce infection rates. We aim to understand the awareness of the test, utilization patterns, barriers to use, and its effect on clinical management.

Methods

A voluntary, email-based, anonymous survey was conducted of urologists in the New York Section of the AUA. SurveyMonkey® was utilized to power the survey and tabulate the results. The inclusion criterion was membership within the New York Section AUA.

Results

Eighty-seven urologists responded. 26.4% of responders reported they were in academic practice, while 74.6% were in some form of private practice. Most responders were not fellowship trained (65.5%), and most have been in practice >20 years (60.9%). A plurality of urologists utilize a single oral and an additional intravenous/intramuscular antibiotic (41.4%). The next most common regimen was a single oral agent (27.7%). 97.7% of responders were aware of rectal swab cultures, but 67.1% do not utilize the test. 18.8% state they utilize the test regularly, and 14.1% use it occasionally. The largest barrier to use is lack of confidence that it will improve outcomes (61.4%) followed by the feasibility of performing the test (42.1%). Among users of rectal swab cultures, 50.0% use the test in all patients before biopsy, while 39.3% of users target patients with a history of sepsis. Of responders utilizing the test, 46.4% stated it changed management at least 20% of the time, and 89.3% state it changes their management at least 10% of the time. Practitioners found it very easy to incorporate into practice (53.6%) or somewhat easy (25.0%), while 0% found it very difficult.

Conclusions

While a majority of urologists are aware of rectal swab cultures, only a small subset regularly uses the test. The major finding is that nearly 50% of users state that it changes prophylaxis at least 20% of the time, and 89% state it changes prophylaxis in at least 10% of patients. Future studies should determine cost-effectiveness and verify a reduction in sepsis rates.

Funding

None