title: Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care.
abstract: OBJECTIVE
  We evaluated targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound guided prostate biopsy based on rectal swab culture results.
  
  
  METHODS
  From July 2010 to March 2011 we studied differences in infectious complications in men who received targeted vs standard empirical ciprofloxacin prophylaxis before transrectal ultrasound guided prostate biopsy. Targeted prophylaxis used rectal swab cultures plated on selective media containing ciprofloxacin to identify fluoroquinolone resistant bacteria. Patients with fluoroquinolone susceptible organisms received ciprofloxacin while those with fluoroquinolone resistant organisms received directed antimicrobial prophylaxis. We identified men with infectious complications within 30 days after transrectal ultrasound guided prostate biopsy using the electronic medical record.
  
  
  RESULTS
  A total of 457 men underwent transrectal ultrasound guided prostate biopsy, and of these men 112 (24.5%) had rectal swab obtained while 345 (75.5%) did not. Among those who received targeted prophylaxis 22 (19.6%) men had fluoroquinolone resistant organisms. There were no infectious complications in the 112 men who received targeted antimicrobial prophylaxis, while there were 9 cases (including 1 of sepsis) among the 345 on empirical therapy (p=0.12). Fluoroquinolone resistant organisms caused 7 of these infections. The total cost of managing infectious complications in patients in the empirical group was $13,219. The calculated cost of targeted vs empirical prophylaxis per 100 men undergoing transrectal ultrasound guided prostate biopsy was $1,346 vs $5,598, respectively. Cost-effectiveness analysis revealed that targeted prophylaxis yielded a cost savings of $4,499 per post-transrectal ultrasound guided prostate biopsy infectious complication averted. Per estimation, 38 men would need to undergo rectal swab before transrectal ultrasound guided prostate biopsy to prevent 1 infectious complication.
  
  
  CONCLUSIONS
  Targeted antimicrobial prophylaxis was associated with a notable decrease in the incidence of infectious complications after transrectal ultrasound guided prostate biopsy caused by fluoroquinolone resistant organisms as well as a decrease in the overall cost of care.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL 60611, USA.
authors.forename: Aisha K
authors.initials: AK
authors.lastname: Taylor
authors.forename: Teresa R
authors.initials: TR
authors.lastname: Zembower
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nadler
authors.forename: Marc H
authors.initials: MH
authors.lastname: Scheetz
authors.forename: John P
authors.initials: JP
authors.lastname: Cashy
authors.forename: Diana
authors.initials: D
authors.lastname: Bowen
authors.forename: Adam B
authors.initials: AB
authors.lastname: Murphy
authors.forename: Elodi
authors.initials: E
authors.lastname: Dielubanza
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Schaeffer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000379:methods; D001424:Bacterial Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D001706:Biopsy / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D012007:Rectum / Q000382:microbiology*; D018084:Ultrasonography, Interventional / Q000379:methods*