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

San Francisco, CA ( 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