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Glick L , Vincent SA , Squadrito D , Han TM , Syed K , Danella JF , Ginzburg S , Guzzo TJ , Lanchoney T , Raman JD , Smaldone M , Uzzo RG , Tomaszweski JJ , Reese A , Singer EA , Jacobs B , Trabulsi EJ , Gomella LG , Mann MJ
Preventing Prostate Biopsy Complications: to Augment or to Swab?
Urology. 2021 Apr 17
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Abstract
OBJECTIVE: To use data from a large, prospectively- acquired regional collaborative database to compare the risk of infectious complications associated with three American Urologic Association- recommended antibiotic prophylaxis pathways, including culture-directed or augmented antibiotics, following prostate biopsy. METHODS: Data on prostate biopsies and outcomes were collected from the Pennsylvania Urologic Regional Collaborative, a regional quality collaborative working to improve the diagnosis and treatment of prostate cancer. Patients were categorized as receiving one of three prophylaxis pathways: culture-directed, augmented, or provider-discretion. Infectious complications included fever, urinary tract infections or sepsis within one month of biopsy. Odds ratios of infectious complication by pathway were determined, and univariate and multivariate analyses of patient and biopsy characteristics were performed. RESULTS: 11,940 biopsies were included, 120 of which resulted in infectious outcomes. Of the total biopsies, 3246 used "culture-directed", 1446 used "augmented" and 7207 used "provider-discretion" prophylaxis. Compared to provider-discretion, the culture-directed pathway had 84% less chance of any infectious outcome (OR= 0.159, 95% CI = [0.074, 0.344], p <0.001). There was no difference in infectious complications between augmented and provider-discretion pathways. CONCLUSIONS: The culture-directed pathway for transrectal prostate biopsy resulted in significantly fewer infectious complications compared to other prophylaxis strategies. Tailoring antibiotics addresses antibiotic-resistant bacteria and reduces future risk of resistance. These findings make a strong case for incorporating culture-directed antibiotic prophylaxis into clinical practice guidelines to reduce infection following prostate biopsies.
Notes
1527-9995 Glick, Lydia Vincent, Sage A Squadrito, Danielle Han, Timothy M Syed, Kaynaat Danella, John F Ginzburg, Serge Guzzo, Thomas J Lanchoney, Thomas Raman, Jay D Smaldone, Marc Uzzo, Robert G Tomaszweski, Jeffrey J Reese, Adam Singer, Eric A Jacobs, Bruce Trabulsi, Edouard J Gomella, Leonard G Mann, Mark J Journal Article United States Urology. 2021 Apr 17:S0090-4295(21)00328-9. doi: 10.1016/j.urology.2021.02.043.