title: Transrectal ultrasound-guided biopsy sepsis and the rise in carbapenem antibiotic use.
abstract: BACKGROUND
  This study sought to determine the number of hospital admissions for sepsis following transrectal ultrasound-guided (TRUS) biopsy, and the rate of both prophylactic and therapeutic use of carbapenem antibiotics for TRUS biopsy, at a single institution.
  
  
  METHODS
  A retrospective review of prospectively collected data from the medical records electronic database of Cabrini Health, a private metropolitan hospital, was queried for coding of admissions under any admitting urologist for sepsis and prostate-related infections from 2009 to 2012. Records were examined for whether a TRUS biopsy had been performed within 14 days prior and if a therapeutic carbapenem was required. The database also queried the use of carbapenems as prophylaxis in patients undergoing TRUS biopsy.
  
  
  RESULTS
  Of the 63 admissions for TRUS biopsy sepsis, multi-drug-resistant organisms were isolated from 26 (41%). Twenty-three admissions were from the 1937 patients who underwent a TRUS biopsy at Cabrini (a sepsis rate of 1.2%) and 40 were following TRUS biopsies at other centres. Thirty-seven (58.7%) patients received therapeutic carbapenems either empirically, or after culture results. Of the 1937 Cabrini TRUS biopsy patients, 154 (8%) were given a carbapenem as prophylaxis, with a rapid increase in prophylactic use over the 4 years studied from 0.25% to 13%.
  
  
  CONCLUSIONS
  This study did not show evidence of an increasing rate of hospital admissions for TRUS biopsy sepsis at this institution. However, there was a dramatic uptake in prophylactic administration of carbapenems. Increasing carbapenem use may contribute to development of carbapenem-resistant bacteria. Alternative methods of prostate biopsy that avoid sepsis should be considered.
authors.affiliation: Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Olivia R
authors.initials: OR
authors.lastname: Leahy
authors.affiliation: Cabrini Health, Melbourne, Victoria, Australia.|Eastern Health, Melbourne, Victoria, Australia.|Monash University, Melbourne, Victoria, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: O'Reilly
authors.affiliation: Monash Health, Melbourne, Victoria, Australia.
authors.forename: David R
authors.initials: DR
authors.lastname: Dyer
authors.affiliation: Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Phillips
authors.affiliation: Alfred Health, Melbourne, Victoria, Australia.|Cabrini Health, Melbourne, Victoria, Australia.|Monash University, Melbourne, Victoria, Australia.|Epworth Healthcare, Melbourne, Victoria, Australia.
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Grummet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015780:Carbapenems / Q000008:administration & dosage*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011469:Prostatic Diseases / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology*; D014463:Ultrasonography / Q000009:adverse effects / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: prostate biopsy; transrectal; urology