title: Comparative Effectiveness of Targeted vs Empirical Antibiotic Prophylaxis to Prevent Sepsis from Transrectal Prostate Biopsy: A Retrospective Analysis.
abstract: OBJECTIVE
  We compared the effectiveness of targeted prophylaxis to the effectiveness of empirical prophylaxis for preventing sepsis after transrectal prostate biopsy using a retrospective multicenter quality improvement study.
  
  
  METHODS
  A total of 13 Kaiser Permanente urology departments participated in a 1-year retrospective analysis of a quality improvement study. In the targeted prophylaxis group rectal cultures were performed before transrectal prostate biopsy and antibiotic sensitivities of Escherichia coli were used to guide the selection of a single agent antibiotic for prophylaxis. Cultures were plated on 10 μg/ml ciprofloxacin infused MacConkey agar at a central laboratory. Urologists using empirical prophylaxis continued the usual regimen of ciprofloxacin monotherapy prophylaxis but sometimes added an additional prophylactic antibiotic. The primary outcome of post-biopsy sepsis was compiled by a search of the electronic medical record for the appropriate ICD-9 codes.
  
  
  RESULTS
  A total of 5,355 prostate biopsy procedures were performed between May 1, 2013 and April 30, 2014. Targeted prophylaxis was used in 1,802 procedures (34%) and empirical prophylaxis was used in 3,553 (66%). The overall incidence of post-biopsy sepsis was 0.52% (28 of 5,355 cases). The incidence of sepsis was 0.44% (8 of 1,802 cases) in the targeted prophylaxis group and 0.56% (20 of 3,553) in the empirical prophylaxis group (p = 0.568). The prevalence of ciprofloxacin resistant E. coli on rectal culture was 25% (444 of 1,802 cases). Seven of the 8 patients (88%) on targeted prophylaxis in whom sepsis developed used a prophylactic antibiotic to which the bacteria causing post-biopsy sepsis were sensitive.
  
  
  CONCLUSIONS
  The targeted prophylaxis protocol enabled physicians to avoid using more than 1 broad-spectrum empirical antibiotic while simultaneously achieving an overall rate of sepsis similar to the rate seen with empirical prophylaxis.
authors.affiliation: Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.affiliation: Department of Urology, University of California-Irvine, Irvine, California.
authors.forename: William
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Urology, University of California-Irvine, Irvine, California.
authors.forename: Dena
authors.initials: D
authors.lastname: Moskowitz
authors.affiliation: Department of Urology, Southern California Kaiser Permanente, Orange County, Irvine, California. Electronic address: Richard.Szabo@kp.org.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Szabo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods; D002939:Ciprofloxacin / Q000627:therapeutic use*; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D024841:Fluoroquinolones; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011467:Prostate / Q000382:microbiology / Q000473:pathology*; D011469:Prostatic Diseases / Q000175:diagnosis; D012007:Rectum; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin
keywords: antibiotic prophylaxis; bacterial; biopsy; drug resistance; fluoroquinolones; prostate