PURPOSE: While transrectal prostate biopsy is the cornerstone of prostate cancer diagnosis, serious post-biopsy infectious complications are reported to be increasing.
A better understanding of the true prevalence and microbiology of these events is needed to guide quality improvement in this area and ultimately better early detection practices.
METHODS: Using data from the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry, we identified all men who underwent transrectal prostate biopsy at 21 practices in Michigan from March 2012 - June 2013. Trained data abstractors recorded pertinent data, including prophylactic antibiotics and all biopsy-related hospitalizations. Claims data and follow-up telephone calls were utilized for validation. All men admitted for an infectious complication were identified and their culture data obtained. We then compared the frequency of infection-related hospitalization rates across practices and according to antibiotic prophylaxis in concordance with AUA best practice recommendations.
RESULTS: The overall 30-day hospital admission rate following prostate biopsy was 0.97%, ranging from 0% to 4.2% across 21 MUSIC practices. Ninety-five percent of admissions were for infectious complications; the majority of cultures identified fluoroquinolone-resistant organisms. AUA concordant antibiotics were administered in 96.3% of biopsies. Patients receiving noncompliant antibiotic regimens were significantly more likely to be hospitalized for infectious complications (3.8% vs. 0.89%, p = 0.0026).
CONCLUSIONS: Infection-related hospitalizations occur in ~1% of men undergoing prostate biopsy in Michigan. Our findings suggest that many of these events could be avoided by implementing new protocols (e.g., culture-specific or augmented antibiotic prophylaxis) that adhere to AUA best practice recommendations and address fluoroquinolone resistance.
Written by:
Womble PR, Dixon MW, Linsell SM, Ye Z, Montie JE, Lane BR, Miller DC, Burks FN. Are you the author?
Department of Urology, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI; Spectrum Health Medical Group, Grand Rapids, MI; Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Reference: J Urol. 2013 Dec 14. pii: S0022-5347(13)06123-5.
doi: 10.1016/j.juro.2013.12.026
PubMed Abstract
PMID: 24345442
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