An antimicrobial prophylaxis protocol using rectal swab cultures for transrectal prostate biopsy.
OBJECTIVE
To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy in our Veterans Affairs population.


METHODS
Between June 1, 2013, and June 1, 2014, we implemented an antimicrobial prophylaxis protocol using rectal swab cultures on selective media containing ciprofloxacin for all men scheduled for TRUS-guided prostate biopsy. Data from 2759 patients from Jan 1, 2006 to May 31, 2013, before protocol implementation served as historical controls. Patients with fluoroquinolone (FQ)-susceptible organisms received FQ monotherapy, while those with FQ-resistant organisms received targeted prophylaxis. Our objective was to compare the rate of infectious complications 30 days after prostate biopsy before and after implementation of our antimicrobial protocol.


RESULTS
One hundred and sixty-seven patients received rectal swab cultures using our protocol. Seventeen (14 %) patients had FQ-resistant positive cultures. Patients with positive FQ-resistant culture results were more likely to have had a history of previous prostate biopsy and a positive urine culture in the last 12 months (p = 0.032, p = 0.018, respectively). The average annual infectious complication rate within 30 days of biopsy was reduced from 2.8 to 0.6 % before and after implementation of our antimicrobial prophylaxis protocol using rectal swab cultures, although this difference was not statistically significant (p = 0.13).


CONCLUSIONS
An antimicrobial prophylaxis protocol using rectal culture swabs is a viable option for prevention of TRUS-guided prostate biopsy infectious complications. After implementation of an antimicrobial prophylaxis protocol, we observed a nonsignificant decrease in the rate of post-biopsy infectious complications when compared to historical controls.
Division of Urology, Department of Surgery, University of Utah Health Care, University of Utah, 30 N 1900 E, RM 3B420, Salt Lake City, UT, 84132, USA.|George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA.
Stephen J
SJ
Summers
Division of Urology, Department of Surgery, University of Utah Health Care, University of Utah, 30 N 1900 E, RM 3B420, Salt Lake City, UT, 84132, USA.
Darshan P
DP
Patel
Division of Urology, Department of Surgery, University of Utah Health Care, University of Utah, 30 N 1900 E, RM 3B420, Salt Lake City, UT, 84132, USA.|George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA.
Blake D
BD
Hamilton
Division of Epidemiology, University of Utah, Salt Lake City, UT, USA.
Angela P
AP
Presson
Department of Pathology, University of Utah, Salt Lake City, UT, USA.|ARUP Laboratories, Salt Lake City, UT, USA.
Mark A
MA
Fisher
Division of Urology, Department of Surgery, University of Utah Health Care, University of Utah, 30 N 1900 E, RM 3B420, Salt Lake City, UT, 84132, USA.|George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA.
William T
WT
Lowrance
Division of Urology, Department of Surgery, University of Utah Health Care, University of Utah, 30 N 1900 E, RM 3B420, Salt Lake City, UT, 84132, USA. Andrew.southwick@hsc.utah.edu.|George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA. Andrew.southwick@hsc.utah.edu.
Andrew W
AW
Southwick
D000368:Aged; D019072:Antibiotic Prophylaxis; D002985:Clinical Protocols; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology*; D012007:Rectum / Q000382:microbiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
Antibiotic prophylaxis/methods; Biopsy/methods; Postoperative complications/prevention and control; Prostate/pathology; Prostate/ultrasonography; Rectum/microbiology