title: Infection related hospitalizations after prostate biopsy in a statewide quality improvement collaborative.
abstract: OBJECTIVE
  While transrectal prostate biopsy is the cornerstone of prostate cancer diagnosis, serious post-biopsy infectious complications are reported to be increasing. A better understanding of the true prevalence and microbiology of these events is needed to guide quality improvement in this area and ultimately better early detection practices.
  
  
  METHODS
  Using data from the MUSIC registry we identified all men who underwent transrectal prostate biopsy at 21 practices in Michigan from March 2012 to June 2013. Trained data abstractors recorded pertinent data including prophylactic antibiotics and all biopsy related hospitalizations. Claims data and followup telephone calls were used for validation. All men admitted to the hospital for an infectious complication were identified and their culture data were obtained. We then compared the frequency of infection related hospitalization rates across practices and according to antibiotic prophylaxis in concordance with AUA best practice recommendations.
  
  
  RESULTS
  The overall 30-day hospital admission rate after prostate biopsy was 0.97%, ranging from 0% to 4.2% across 21 MUSIC practices. Of these hospital admissions 95% were for infectious complications and the majority of cultures identified fluoroquinolone resistant organisms. AUA concordant antibiotics were administered in 96.3% of biopsies. Patients on noncompliant antibiotic regimens were significantly more likely to be hospitalized for infectious complications (3.8% vs 0.89%, p=0.0026).
  
  
  CONCLUSIONS
  Infection related hospitalizations occur in approximately 1% of men undergoing prostate biopsy in Michigan. Our findings suggest that many of these events could be avoided by implementing new protocols (eg culture specific or augmented antibiotic prophylaxis) that adhere to AUA best practice recommendations and address fluoroquinolone resistance.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Womble
authors.affiliation: University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Maxwell W
authors.initials: MW
authors.lastname: Dixon
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Linsell
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Zaojun
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.affiliation: Spectrum Health Medical Group, Grand Rapids, Michigan.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. Electronic address: fburks@urologist.org.
authors.forename: Frank N
authors.initials: FN
authors.lastname: Burks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000592:standards*; D001424:Bacterial Infections / Q000517:prevention & control*; D001706:Biopsy / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D058996:Quality Improvement; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: anti-bacterial agents; biopsy; complications; infection; prostate