ACS 2018: Trends and Characteristics of Prophylactic Antibiotics for Men Undergoing Prostate Biopsy

Boston, Massachusetts ( Mark Henry evaluated trends in antibiotic use for prostate biopsies and characterized trends in use of oral and parenteral antibiotics. Using a database of private insurance claims (2009 - 2015), they identified men undergoing prostate biopsy. Payments for oral antibiotics in the 30 days prior to, and parenteral antibiotics on the day of the procedure were captured. Antibiotics were identified using the National Drug Code Directory or HCPCS codes linked to pharmaceutical and outpatient service claims. Impact of covariates on antibiotic use was estimated with logistic regression models. 

They identified 334,929 biopsies, of which 65% were associated with claims for prophylactic antibiotics. Prophylactic increased significantly over time (56% in 2009 to 82% in 2015, p<0.001). Rural patients and those with 3+ comorbidities were more likely to receive oral antibiotics (both p<0.001). The proportion of augmented antibiotic regimens increased over the study period, from 5.2% in 2009 to 24.9% in 2015. Fluoroquinolones were the most utilized oral antibiotic, though utilization decreased over time (76.8% in 2009 to 71.7% in 2015, p<0.001).

In summary, use of prophylactic antibiotics for prostate biopsy has increased over time, with a notable increase in regimens incorporating parenteral antibiotic administration. Fluoroquinolones remain the mainstay of oral therapy, though their use is decreasing over time. Importantly, these data highlight the need for the mechanics of the procedure to change from transfecal to transperineal where no antibiotics are used with elimination of infectious complications/sepsis and antibiotic side effect concerns.

Presented by: Mark Henry, Emory University School of Medicine, Decatur, GA 

Written by: Stephen B. Williams, MD., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, MD. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts