Comparative Effectiveness of Targeted vs Empirical Antibiotic Prophylaxis to Prevent Sepsis from Transrectal Prostate Biopsy: A Retrospective Analysis

Abstract

The targeted prophylaxis protocol enabled physicians to avoid using more than 1 broad-spectrum empirical antibiotic while simultaneously achieving an overall rate of sepsis similar to the rate seen with empirical prophylaxis.

Impact of Rectal Swabs on Infectious Complications after Transrectal Prostate Biopsy

“…Taylor et al [29] showed a non-statistically significant reduction in the frequency of sepsis using targeted prophylaxis with rectal culture versus standard prophylaxis (0 vs. 2.6%, p = 0.12). Liss et al [30] reported similar findings in a retrospective analysis of 5,355 prostate biopsies. The incidence of post-PB sepsis between the empirical versus targeted prophylaxis group was not significantly different (0.56 vs. 0.44%, p = 0.568), however, targeted therapy prevented the use of more than one broad-spectrum empirical antibiotic.…”

“…The rate of FQ-resistance in patients with pre-PB rectal culture ranges between 3.7 and 25% [30,31,32,33]. In our study, FQ-resistance was 45.62%.…”

A single dose of meropenem is superior to ciprofloxacin in preventing infections after transrectal ultrasound-guided prostate biopsies in the era of quinolone resistance

“…Loeb et al indicated that men undergoing TRUSP-Bx were 2.26 times more likely to be hospitalized for infectious complications comparing to randomly selected controls [1]. Liss et al [19] concluded that their targeted prophylaxis protocol, including rectal cultures performed before transrectal prostate biopsy, enabled physicians to avoid using more than one broad-spectrum empirical antibiotic, while achieving an overall rate of sepsis similar to the rate seen with empirical prophylaxis. One of our patients died in the ICU due to multi-resistant E. coli septic shock.…”

Cutting to the Core of the Issue: Emerging Strategies To Reduce Prostate Biopsy-Related Infections

“…The California study compared targeted prophylaxis to empirical prophylaxis, which included both single-agent and augmented approaches (75% single agent and 25% augmented). No significant decrease in sepsis postintervention was observed, even when single-agent empirical prophylaxis was considered separately from augmented prophylaxis (30). Many smaller studies have shown a trend toward reduction but did not reach statistical significance, as they may not have been powered adequately to detect differences.…”

“…Two of the largest studies to address these questions were quality improvement initiatives in the state of Michigan and urology departments in Southern California that evaluated infection rates following a quality intervention (17,30). The Michigan study demonstrated a 53% decrease in biopsy-infection-related hospitalizations for the combined intervention of either augmented or targeted prophylaxis compared to the standard prophylaxis chosen by the physician (17).…”