1078 Risk Factors for Complications After Prostate Biopsy at the Va

Lay, Aaron; Kaplan, Joshua R.; Williams, Stephen; Siroky, Mike B.; Orlando, Ralph

doi:10.1016/j.juro.2012.02.1185

Journal of Urology

2012

DOI: 10.1016/j.juro.2012.02.1185

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1078 Risk Factors for Complications After Prostate Biopsy at the Va

Aaron Lay

Joshua R. Kaplan

Stephen Williams

et al.

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“…Unfortunately, fluoroquinolone resistance among E. coli organisms is increasing, with reported rates as high as 22% in patients undergoing a urological procedure (4). A recent study showed the rate of postprocedure infection after TRUS biopsy to be 2.65% and on an upward trend from 2006 to 2010 (5). Based on these data and other studies of alternative prophylactic regimens, the preferred prophylactic regimen at our institution was changed from ciprofloxacin to ciprofloxacin plus cefpodoxime in late 2012.…”

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confidence: 89%

Comparative Effectiveness of Single versus Combination Antibiotic Prophylaxis for Infections after Transrectal Prostate Biopsy

Marino

Parlee

Orlando

et al. 2015

Antimicrob Agents Chemother

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An increase in fluoroquinolone resistance and transrectal ultrasound-guided prostate (TRUS) biopsy infections has prompted the need for alternative effective antibiotic prophylaxis. We aimed to compare ciprofloxacin and other single-agent therapies to combination therapy for efficacy and adverse effects. Men who underwent a TRUS biopsy within the VA Boston health care system with documented receipt of prophylactic antibiotics periprocedure were eligible for inclusion. Postprocedure infections within 30 days were ascertained by chart review from electronic records, including any inpatient, outpatient, or urgent-care visits. Among 455 evaluable men over a 3-year period, there were 25 infections (5.49%), with sepsis occurring in 2.4%, urinary tract infections (UTI) in 1.54%, and bacteremia in 0.44% of patients. Escherichia coli was the most common urine (89%) and blood (92%) pathogen, with fluoroquinolone resistance rates of 88% and 91%, respectively. Ciprofloxacin alone was associated with significantly more infections than ciprofloxacin plus an additional agent (P ‫؍‬ 0.014). Intramuscular gentamicin alone was also significantly associated with a higher infection rate obtained with all other regimens (P ‫؍‬ 0.004). Any single-agent regimen, including ciprofloxacin, ceftriaxone, or gentamicin, was associated with significantly higher infection rates than any combination regimen (odds ratio [OR], 4; 95% confidence interval [CI], 1.47, 10.85; P ‫؍‬ 0.004). Diabetes, immunosuppressive condition or medication, hospitalization within the previous year, and UTI within the previous 6 months were not associated with infection risk. Clostridium difficile infections were similar. These findings suggest that ciprofloxacin, ceftriaxone, and gentamicin alone are inferior to a combination regimen. Institutions with high failure rates of prophylaxis for TRUS biopsies should consider combination regimens derived from their local data.

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confidence: 89%

Comparative Effectiveness of Single versus Combination Antibiotic Prophylaxis for Infections after Transrectal Prostate Biopsy

Marino

Parlee

Orlando

et al. 2015

Antimicrob Agents Chemother

Self Cite

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1078 Risk Factors for Complications After Prostate Biopsy at the Va

Cited by 1 publication

References 0 publications

Comparative Effectiveness of Single versus Combination Antibiotic Prophylaxis for Infections after Transrectal Prostate Biopsy

Comparative Effectiveness of Single versus Combination Antibiotic Prophylaxis for Infections after Transrectal Prostate Biopsy

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