Mp34-19 hematuria Referrals at a Safety Net Hospital: A Focus on Patient Demographics and Compliance

Abstract

INTRODUCTION AND OBJECTIVE: Rising antibiotic resistance has driven antibiotic stewardship to minimize antibiotic use while maintaining low peri-procedural infectious complications. Our objective was to assess if appropriately augmented antibiotic regimen during transrectal prostate biopsies would reduce infectious complications in high-risk patients based on our departmental antibiotic stewardship protocol METHODS: A retrospective review of 413 patients undergoing transrectal prostate biopsies were done from January 1 st to December 31 st , 2020 during the implementation of our antibiotic stewardship protocol. We implemented a survey in clinic designed to identify high risk patients pre-prostate biopsy. High-risk patients received augmented antibiotics with either ceftriaxone or gentamicin in addition to one standard dose of a fluoroquinolone. We fit multivariable logistic regression models to assess the relationship between antibiotic regimen and infectious complications.RESULTS: Of the 413 patients who underwent transrectal prostate biopsies, 22 (5%) had 30-day infectious complications. The majority of patients, 338 (82%) received appropriate antibiotics as dictated by our protocol. Of the 22 patients with infectious complications, 9 (41%) received augmented antibiotics as indicated, 2 (10%) did not receive augmented antibiotics as indicated, 1 (4%) received augmented antibiotics when not indicated, 9 (41%) did not receive augmented antibiotics as indicated and 1(4%) was unknown. Inappropriate antibiotic regimen received was not an independent predictor of increased infectious complications (odds ratio [OR] 1.37, 95% CI 0.28-6.78) CONCLUSIONS: The majority of our patients received appropriate antibiotics during our intervention. Despite augmented antibiotics, over 40% of infections occurred in this group. Further intervention beyond antimicrobial augmentation should be considered for these high-risk patients such as rectal swab cultures, longer duration of antibiotics or change to perineal prostate biopsy.