title: A Statewide Intervention to Reduce Hospitalizations after Prostate Biopsy.
abstract: OBJECTIVE
  Recent data suggest that increasing rates of hospitalization after prostate biopsy are mainly due to infections from fluoroquinolone-resistant bacteria. We report the initial results of a statewide quality improvement intervention aimed at reducing infection related hospitalizations after transrectal prostate biopsy.
  
  
  METHODS
  From March 2012 through May 2014 data on patient demographics, comorbidities, prophylactic antibiotics and post-biopsy complications were prospectively entered into an electronic registry by trained abstractors in 30 practices participating in the MUSIC. During this period each practice implemented one or both of the interventions aimed at addressing fluoroquinolone resistance, namely 1) use of rectal swab culture directed antibiotics or 2) augmented antibiotic prophylaxis with a second agent in addition to standard fluoroquinolone therapy. We identified all patients with an infection related hospitalization within 30 days after biopsy and validated these events with claims data for a subset of patients. We then compared the frequency of infection related hospitalizations before (5,028 biopsies) and after (4,087 biopsies) implementation of the quality improvement intervention.
  
  
  RESULTS
  Overall the proportion of patients with infection related hospitalizations after prostate biopsy decreased by 53% from before to after implementation of the quality improvement intervention (1.19% before vs 0.56% after, p=0.002). Among post-implementation biopsies the rates of hospitalization were similar for patients receiving culture directed (0.47%) vs augmented (0.57%) prophylaxis. At a practice level the relative change in hospitalization rates varied from a 7.4% decrease to a 3.0% increase. Fourteen practices had no post-implementation hospitalizations.
  
  
  CONCLUSIONS
  A statewide intervention aimed at addressing fluoroquinolone resistance reduced post-prostate biopsy infection related hospitalizations in Michigan by 53%.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Womble
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: Yuqing
authors.initials: Y
authors.lastname: Gao
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: Division of Infectious Disease, University of Michigan, Ann Arbor, Michigan.
authors.forename: Tejal N
authors.initials: TN
authors.lastname: Gandhi
authors.affiliation: Department of Urology, Spectrum Health Medical Group, Grand Rapids, Michigan.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
authors.forename: Frank N
authors.initials: FN
authors.lastname: Burks
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: dcmiller@med.umich.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011469:Prostatic Diseases / Q000175:diagnosis; D058996:Quality Improvement; D012007:Rectum; D012189:Retrospective Studies
keywords: anti-bacterial agents; biopsy; infection; prostate; quality improvement