Topical antiseptic at time of transrectal ultrasound prostate biopsy is associated with fewer severe clinical infections and improves antibiotic stewardship

Abstract

Background The 2017 AUA White Paper on prevention of prostate needle biopsy (PNB) complications highlights an algorithm for reducing procedural related infections. The incorporation of topical rectal antiseptic (TRS) at time of transrectal PNB is listed as one such modality. We present data on over 1000 transrectal PNB procedures to determine the impact of TRS on 1) infectious complications and 2) use of augmented procedural antibiotics. Methods The records of 1181 transrectal PNB procedures performed over a 10-year period were reviewed. In 2013, TRS with either 10% povidone iodine or 4% chlorhexidine was more regularly incorporated into PNB procedures. Clinical and procedural factors were analyzed for association with post-procedure infections. Infectious complications outcomes were compared in patients receiving TRS (n = 566) versus those who had not (n = 615). Results A total of 990 men underwent 1181 transrectal PNB procedures. Median age of the cohort was 63 years with a median PSA of 7 ng/dL. Of them, 86% of the men were Caucasian, 28% had undergone at least one prior biopsy, 14% were diabetic, and 6% had prior hospitalization within 6 months of the procedure. Five hundred sixty-six patients (48%) received TRS at time of biopsy. Perioperative IV adjunctive antibiotics were used less frequently in patients receiving TRS (13.4% vs. 28.6%, p < 0.001). Furthermore, patients receiving TRS experienced lower rates of clinical infections (1.2% vs. 2.4%, p = 0.14), as well as lower likelihood of severe infections evidenced by decreased rates of hospital admission (0.5% vs. 2.3%, p = 0.013). Rectal vault bacteriology obtained before and after TRS was available in 180 men noting a 98.1% decrease in colony counts after local treatment. Conclusions TRS at time of transrectal PNB was associated with decreased use of IV procedural antibiotics as well as decreased severity of infections post-biopsy. This simple technique enhances antibiotic stewardship while simultaneously improving quality outcomes of the procedure.

Transperineal vs. transrectal biopsy to reduce postinterventional sepsis

“…Ramedani et al [14] examined the impact of preprocedural use of a topical rectal antiseptic (TRA), in addition to periprocedural antibiotic prophylaxis, aiming to reduce severe clinical infections. Sepsis was defined with bacteriemia and occurred after five (0.4%) procedures overall.…”

“…Sepsis was defined with bacteriemia and occurred after five (0.4%) procedures overall. The incidence rate of sepsis was higher in those without the application of a TRA (0.7%) compared with those with TRA (0.2%), but this finding did not reach statistical significance ( P = 0.38) [14]. A Turkish series also evaluated the impact of TRA on postprocedural infectious complications.…”

Non-infectious complications following transrectal prostate needle biopsy – Outcomes from over 8000 procedures

“… 6 Contemporary data highlight an increase in PNB-related infections 7 and accordingly algorithms with the goal of decreasing these inherent infectious risks have been proposed. 8 , 9 , 10 …”

Molecular genetic testing does not improve the detection of fluoroquinolone resistance before transrectal prostate biopsy

“… 4 Previous studies have linked infections to colonization status of fluoroquinolone-resistant (FQR) Escherichia coli ( E. coli ) identified in asymptomatic individuals prompting alternate prophylaxis regimens. 5 , 6 – 7 …”