AUA 2018: Implementation of a Novel Point of Care PCR Test to Guide Antibiotic Prophylaxis Prior to Transrectal Prostate Biopsy

San Francisco, CA (UroToday.com) Michael A. Liss, MD opened this session stating that post prostate biopsy infections remain a significant concern.  There has been a slow implementation of perineal biopsy and pre-biopsy cultures to date.  Antibiotic stewardship has been gaining traction as a quality measure.  The objective of this study was to implement a point of care test for antibiotic selection.  This PCR based test (EST200) targets multidrug resistant clonal groups, ST131 and ST69, that are a series representing the most common cause of E Coli sepsis from prostate biopsy with expanding resistance patterns.

Rectal swabs were obtained 2-6 weeks prior to biopsy or the day of the biopsy.  Two cultures were taken – one for culture for Ciprofloxacin infused agar and sensitivity testing.  The second was for real-time PCR analysis.  Techniques and results were compared. 

140 men participated in this study, with pre-biopsy culturing guiding antibiotic usage in 102 patients.  Men without pre-biopsy cultures were randomized to PCR based antibiotic result to physician’s antibiotic of choice.  Cultures had a higher inadequate result compared to PCR (p<0.01).  Pre-biopsy culture demonstrated an area under the curve of 0.91 compared to PCR of 0.71 (p=0.005).  PCR had a false positive rate of 27% and missed 29% of fluoroquinolone resistance.  Additionally, average clinic time was 67 minutes longer with the PCR test. 

In summary, rapid PCR has a moderate ability to detect fluoroquinolone resistance patterns.  Sepsis is caused by ST131:H30 in approximately 80% of cases.  Liss stated that PCR time needs to be less than 20 minutes to keep the clinic running efficiently.


Presented by: Michael A. Liss, MD, University of Texas-San Antonio

Written by: David B. Cahn, DO, MBS Fox Chase Cancer Center Philadelphia, PA @dbcahn at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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