Northeastern Section of the American Urological Association 64th Annual Meeting, Niagara Falls, Ontario Scientific Program

Infections following prostate biopsy can be associated with significant morbidity and occasional mortality. Studies have suggested an increased incidence in post-biopsy sepsis. The purpose of this study was to determine the effect of a bacteria sensitivity adapted antimicrobial prophylactic strategy...

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Bibliographic Details
Published in:Canadian Urological Association journal 2012-08, Vol.6 (4), p.275-325
Main Authors: Rowe, Neal E, Breau, Rodney H, Cagiannos, Ilias, Zvonar, Rosemary, Fergusson, Dean, Lavallee, Luke T, Mallick, Ranjeeta, Morash, Christopher G
Format: Article
Language:English
Subjects:
Aminoglycosides
Bacteria
Canada
China
Ciprofloxacin
Health aspects
Illinois
Infection
Massachusetts
Mortality
New York
Ontario
Pennsylvania
Quebec
Saudi Arabia
Spain
Sweden
Transplantation of organs, tissues, etc
United Kingdom
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Summary:Infections following prostate biopsy can be associated with significant morbidity and occasional mortality. Studies have suggested an increased incidence in post-biopsy sepsis. The purpose of this study was to determine the effect of a bacteria sensitivity adapted antimicrobial prophylactic strategy on the incidence of sepsis post prostate biopsy. In October 2008, based on the prevalence of ciprofloxacin-resistant E.coli in the region, our institution modified the prophylactic regimen for prostate biopsy from oral ciprofloxacin alone to a combination of single-dose ciprofloxacin and trimethoprim/sulfamethoxazole. If patients had a history of urosepsis, bacterial prostatitis, organ transplant, or fluoroquinolone use in the preceding 12 months, intramuscular ceftriaxone was administered for prophylaxis. Patients with penicillin allergy received gentamicin. We determined the incidence of ciprofloxacin-resistant bacteremia 16 months before and 16 months after the change in antibiotic protocol. Between June 2007 and September 2008, 9 of 847 (1.06%) patients were admitted with prostate biopsy induced bacteremia secondary to ciprofloxacin-resistant E. coli. In the 16 months following introduction of the described prophylactic regimen, 1 of 989 (0.10%) patients suffered ciprofloxacin-resistant sepsis. The absolute reduction in E. coli sepsis was 0.96% (95%CI 0.2% to 1.7%; p=0.007). The number needed to treat is 104. Bacterial susceptibility to antimicrobial agents is in evolution. Using a regional bacteria sensitivity based approach to biopsy prophylaxis, we have significantly decreased ciprofloxacin-resistant E. coli sepsis in our patients. Regional bacteria sensitivity based protocols may decrease the incidence at other centers and warrants further study.
ISSN:1911-6470
1920-1214