title: Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic prophylaxis.
abstract: OBJECTIVE
  We evaluated the incidence of infectious complications requiring hospitalization after transrectal ultrasound guided prostate biopsy, comparing an augmented regimen of antibiotic prophylaxis to the standard regimen, and established cost-effectiveness at our center.
  
  
  METHODS
  Our standard antibiotic prophylaxis regimen consisted of 3 days of ciprofloxacin or Bactrim™ DS in the perioperative period. An increase in hospital admissions related to infection after transrectal ultrasound guided biopsy from January 2010 through December 2010 led us to initiate an augmented regimen of 3 days of ciprofloxacin or Bactrim DS in addition to 1 dose of intramuscular gentamicin before biopsy from January 2011 to December 2011. Urine and blood cultures along with bacterial susceptibilities were obtained at admission and compared between the 2 groups. Cost analysis was done to determine the cost-effectiveness of standard and augmented regimens.
  
  
  RESULTS
  The rate of hospitalization due to post-biopsy infections was 3.8% (11 patients among 290 biopsies) in 2010, which decreased to 0.6% (2 patients among 310 biopsies) in 2011 (p <0.001). Of the admitted patients who received standard prophylaxis, 73% had fluoroquinolone resistant Escherichia coli urinary infection and/or bacteremia and only 9% had strains resistant to gentamicin. Multivariate analysis showed that the standard regimen was significantly associated with hospital admission due to post-biopsy infection (HR 2.078 ± 0.84, p = 0.013). The augmented regimen resulted in a cost savings of $15,700 per 100 patients compared to the standard regimen.
  
  
  CONCLUSIONS
  The addition of gentamicin to current prophylactic regimens significantly reduced the rate of hospitalization for post-biopsy infectious complications and was shown to be cost-effective.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
authors.forename: Mehrad
authors.initials: M
authors.lastname: Adibi
authors.forename: Brad
authors.initials: B
authors.lastname: Hornberger
authors.forename: Deepa
authors.initials: D
authors.lastname: Bhat
authors.forename: Ganesh
authors.initials: G
authors.lastname: Raj
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
mesh_terms: D019072:Antibiotic Prophylaxis / Q000592:standards*; D001424:Bacterial Infections / Q000517:prevention & control*; D001706:Biopsy / Q000009:adverse effects; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000517:prevention & control*; D011467:Prostate / Q000473:pathology*; D012189:Retrospective Studies