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Published on: September 21, 2015
Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic
Mehrad Adibi1, Brad Hornberger, Deepa Bhat
1University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
Purpose:
We evaluated the incidence of infectious complications requiring hospitalization after transrectal ultrasound guided prostate biopsy, comparing an augmented regimen of antibiotic prophylaxis to the standard regimen, and established cost-effectiveness at our center.
Materials And Methods:
Our standard antibiotic prophylaxis regimen consisted of 3 days of ciprofloxacin or Bactrim™ DS in the perioperative period. An increase in hospital admissions related to infection after transrectal ultrasound guided biopsy from January 2010 through December 2010 led us to initiate an augmented regimen of 3 days of ciprofloxacin or Bactrim DS in addition to 1 dose of intramuscular gentamicin before biopsy from January 2011 to December 2011. Urine and blood cultures along with bacterial susceptibilities were obtained at admission and compared between the 2 groups. Cost analysis was done to determine the cost-effectiveness of standard and augmented regimens.
Results:
The rate of hospitalization due to post-biopsy infections was 3.8% (11 patients among 290 biopsies) in 2010, which decreased to 0.6% (2 patients among 310 biopsies) in 2011 (p <0.001). Of the admitted patients who received standard prophylaxis, 73% had fluoroquinolone resistant Escherichia coli urinary infection and/or bacteremia and only 9% had strains resistant to gentamicin. Multivariate analysis showed that the standard regimen was significantly associated with hospital admission due to post-biopsy infection (HR 2.078 ± 0.84, p = 0.013). The augmented regimen resulted in a cost savings of $15,700 per 100 patients compared to the standard regimen.
Conclusions:
The addition of gentamicin to current prophylactic regimens significantly reduced the rate of hospitalization for post-biopsy infectious complications and was shown to be cost-effective.
Insights
Adding gentamicin to antibiotic prophylaxis for transrectal ultrasound guided prostate biopsy significantly reduced hospitalizations for infections. This augmented regimen proved cost-effective, lowering infection rates and saving costs.
Area of Science:
- Urology
- Infectious Diseases
- Health Economics
Background:
- Transrectal ultrasound guided prostate biopsy is associated with infectious complications.
- Rising hospital admissions due to infection prompted a review of standard antibiotic prophylaxis.
- Fluoroquinolone-resistant *Escherichia coli* was a significant concern in post-biopsy infections.
Purpose of the Study:
- To evaluate the incidence of infectious complications requiring hospitalization after transrectal ultrasound guided prostate biopsy.
- To compare an augmented antibiotic prophylaxis regimen with the standard regimen.
- To establish the cost-effectiveness of the augmented regimen.
Main Methods:
- Standard prophylaxis: 3 days of ciprofloxacin or Bactrim™ DS.
- Augmented prophylaxis: Standard regimen plus 1 dose of intramuscular gentamicin.
- Comparison of hospitalization rates, bacterial cultures, susceptibilities, and cost analysis between 2010 (standard) and 2011 (augmented).
Main Results:
- Hospitalization rate for post-biopsy infections decreased from 3.8% in 2010 to 0.6% in 2011 (p <0.001).
- Standard prophylaxis patients frequently had fluoroquinolone-resistant *E. coli*; augmented regimen showed better resistance profiles.
- The augmented regimen resulted in cost savings of $15,700 per 100 patients.
Conclusions:
- Addition of gentamicin to prophylactic regimens significantly reduced hospitalizations for post-biopsy infectious complications.
- The augmented regimen is a cost-effective strategy for preventing infectious complications.
- This approach addresses the challenge of fluoroquinolone-resistant pathogens.
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