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Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Targeted Antimicrobial Prophylaxis Does Not Always Prevent Sepsis after Transrectal Prostate Biopsy
Pengbo Jiang1, Michael A Liss2, Richard J Szabo3
1Department of Urology, University of California-Irvine, Irvine, California.
Purpose:
We compared the effectiveness of targeted prophylaxis to augmented empirical prophylaxis and single agent empirical prophylaxis to prevent sepsis after transrectal prostate biopsy.
Materials And Methods:
We retrospectively reviewed the records of transrectal prostate biopsies performed during 3 years at 13 Southern California Kaiser Permanente® departments of urology. Targeted prophylaxis was guided by rectal culture bacterial susceptibility for use of a single prophylactic antibiotic while for empirical prophylaxis 1 antibiotic (single agent empirical prophylaxis) or multiple antibiotics (augmented empirical prophylaxis) were given according to the usual practice of the urologist. Sepsis was the primary outcome analyzed.
Results:
We reviewed 15,236 transrectal prostate biopsy cases. Targeted prophylaxis, single agent empirical prophylaxis and augmented empirical prophylaxis were administered in 26%, 58% and 16% of cases, respectively. The overall incidence of post-biopsy sepsis was 0.64%. On multivariable analysis there was no significant difference in the rate of post-biopsy sepsis after targeted prophylaxis compared to empirical prophylaxis (single agent and augmented empirical prophylaxis together) (OR 0.86, 95% CI 0.53-1.41, p = 0.561). However, on subanalysis augmented empirical prophylaxis showed a significantly lower incidence of sepsis than single agent empirical or targeted prophylaxis (OR 0.35, 95% CI 0.16-0.76, p = 0.008). Based on blood and urine cultures 38% of the patients with sepsis after transrectal prostate biopsy had been given the correct prophylactic antibiotic prior to biopsy. On multivariable analysis Asian/Pacific Islander or Hispanic/Latino ethnicity was associated with a higher incidence of harboring fluoroquinolone resistant bacteria on rectal swab cultures.
Conclusions:
This large retrospective study showed that augmented empirical prophylaxis was statistically superior to single agent empirical and targeted prophylaxis. Sepsis developed in a significant number of patients despite being given a prophylactic antibiotic to which the sepsis causing bacteria were sensitive.
Insights
Augmented empirical prophylaxis significantly reduced sepsis after prostate biopsies compared to targeted or single-agent methods. This approach offers improved sepsis prevention in transrectal prostate biopsy patients.
Area of Science:
- Urology
- Infectious Disease Prevention
- Antibiotic Prophylaxis
Background:
- Sepsis is a serious complication following transrectal prostate biopsy.
- Current prophylaxis strategies include targeted and empirical approaches.
- Optimizing antibiotic use is crucial to prevent post-biopsy infections.
Purpose of the Study:
- To compare the effectiveness of targeted prophylaxis versus augmented empirical prophylaxis and single-agent empirical prophylaxis in preventing sepsis after transrectal prostate biopsy.
Main Methods:
- Retrospective review of 15,236 transrectal prostate biopsy cases over 3 years.
- Analysis of sepsis incidence based on prophylaxis type: targeted, single-agent empirical, and augmented empirical.
- Multivariable analysis to assess the impact of prophylaxis strategy on sepsis rates.
Main Results:
- Augmented empirical prophylaxis demonstrated a significantly lower incidence of sepsis (OR 0.35) compared to single-agent empirical or targeted prophylaxis.
- No significant difference in sepsis rates was found between targeted and overall empirical prophylaxis.
- 38% of sepsis cases occurred despite patients receiving a seemingly appropriate prophylactic antibiotic.
Conclusions:
- Augmented empirical prophylaxis is statistically superior to single-agent empirical and targeted prophylaxis for preventing sepsis post-transrectal prostate biopsy.
- Sepsis can occur even when patients receive prophylactic antibiotics to which the causative bacteria are sensitive.
- Further research into antibiotic resistance patterns and prophylaxis optimization is warranted.
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