Abstract: PD43-07
Sources of Funding: none

Introduction

Sepsis is a significant complication following transrectal ultrasound-guided prostate biopsy (TRUSBx). Ciprofloxacin and gentamicin are commonly used for prophylaxis, however there is emerging evidence for an increase in incidence of resistant enteric organisms observed worldwide. We investigate the effect of rectal swab cultures and sensitivities for targeted prophylactic antimicrobial regimes in reducing the risk of sepsis following TRUSBx

Methods

All patients had confirmed negative urinalysis prior to biopsy. 609 patients (Group A) received a prophylactic antimicrobial regime of a single intravenous dose of gentamicin 240mg, rectal metronidazole 1g and oral ciprofloxacin 500mg twice daily for 3 days._x000D_ Due to a significant incidence of ciprofloxacin and gentamicin resistance in patients admitted with sepsis following TRUBx, our local antibiotic recommendations changed. The subsequent 231 patients (Group B) had rectal swab cultures and sensitivities performed prior to biopsy. Patients with rectal flora organisms resistant to ciprofloxacin or gentamicin received targeted antimicrobial prophylaxis consisting of a single dose oral fosfomycin 3g, intravenous amikacin 750mg and rectal metronidazole 1g. _x000D_ Data was collected for rectal swab cultures, antibiotic regime used, readmission with sepsis within 14 days and blood or urine cultures results on admission.

Results

In group A (standard ciprofloxacin-based regime), 12 of 609 (1.9%) patients were admitted with sepsis following biopsy. E.coli was the most common pathogen detected. Of the 7 patients with positive urine or blood cultures, 4 (57%) were ciprofloxacin- and gentamicin-resistant and 2 (29%) were ciprofloxacin-resistant only._x000D_ In group B, 38 of 231 (16.5%) patients had ciprofloxacin or gentamicin resistant rectal flora and received the targeted antimicrobial prophylaxis regime (25 ciprofloxacin-resistant only, 3 gentamicin-resistant only, 10 ciprofloxacin- and gentamicin-resistant). _x000D_ Overall in group B, 5 of 231 (2.1%) patients were readmitted with sepsis despite receiving targeted combination of prophylactic antibiotics based on their rectal swab cultures. Of these patients, 2 had grown ciprofloxacin-resistant organisms on rectal swab and received the appropriate antimicrobial prophylaxis regime. The difference between the two groups was not statistically significant (p=0.86).

Conclusions

The incidence of ciprofloxacin-resistant flora in our community is significant (15.2%). The risk of sepsis following TRUSBx was overall low, however the use of rectal swab cultures and targeted combination of antibiotic regimes did not seem to reduce the risk any further.

Funding

none