Login to Access Video or Poster Abstract: MP96-06
Sources of Funding: None

Introduction

Infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) has steadily increased owing to rising rates of quinolone resistance. Topical cleansing agents such as povidone iodine or chlorhexidine can decrease the rectal vault bacterial load thereby potentially reducing risk of infection. In 2012, a resident quality improvement project was initiated at our hospital to investigate the impact of topical rectal vault cleansing on infection rates following TRUS PNB. We report outcomes four years after initiating this quality measure.

Methods

A retrospective chart review was conducted on 982 men who underwent TRUS PNB between 2010 and 2016. Comparison groups includes those who received a topical rectal antiseptic (n=400) compared to those who did not (n=582). Povidone-iodine (n=302) or 4% chlorhexidine solution without alcohol (n=98) were topical antiseptic agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring.

Results

Median age and PSA of men included in this study were 64 years and 12ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on chronic immunosuppression, 32% had undergone at least one prior biopsy, 14% had received antibiotics in the past 6 months, and 7% were hospitalized in this same time frame. Almost 30% of men had a prior prostate biopsy. Baseline clinical and demographic variables were similar between the two groups (Table) except for perioperative IV antibiotics use which was higher in the group not receiving topical rectal antiseptic (16% vs. 6%, p<0.0001). Overall, 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8% vs. 3.3%, p=0.01). Post-biopsy UTI rates (p=0.04) and hospital admission (p=0.03) were also lower in the topical antiseptic group with trends to reduction in blood culture positive sepsis and need for ICU monitoring.

Conclusions

What started as a resident quality safety project 4 years ago has clearly demonstrated a reduction in infections and hospital admission follow TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.

Funding

None