An antimicrobial prophylaxis protocol using rectal swab cultures for transrectal prostate biopsy

Area of Science:

• Infectious Diseases
• Urology
• Antimicrobial Stewardship

Background:

• Transrectal ultrasound (TRUS)-guided prostate biopsy is associated with infectious complications.
• Antimicrobial prophylaxis is standard, but resistance patterns necessitate optimized protocols.
• Rectal swab cultures can guide targeted antimicrobial prophylaxis.

Purpose of the Study:

• To evaluate the effectiveness of an antimicrobial prophylaxis protocol using rectal swab cultures for TRUS-guided prostate biopsy.
• To assess the impact on infectious complication rates in a Veterans Affairs population.

Main Methods:

• Prospective implementation of a rectal swab culture protocol with selective media (ciprofloxacin).
• Patients with fluoroquinolone (FQ)-susceptible organisms received FQ monotherapy; FQ-resistant organisms received targeted prophylaxis.
• Comparison of infectious complication rates (30-day) against historical controls (2759 patients).

Main Results:

• 167 patients underwent the new protocol; 14% had FQ-resistant organisms.
• History of prior biopsy and recent positive urine culture were associated with FQ resistance.
• Average annual infectious complication rate decreased from 2.8% to 0.6%, a non-significant difference (p=0.13).

Conclusions:

• Antimicrobial prophylaxis guided by rectal swab cultures is a feasible strategy for TRUS-guided prostate biopsy.
• The protocol demonstrated a trend towards reduced infectious complications.
• Further research may be warranted to achieve statistical significance in complication reduction.