Rectal swab testing before prostate biopsy: experience in a VA Medical Center urology practice.

Infectious complications following transrectal ultrasound prostate biopsy (TRUSBx) have been increasing. Pre-biopsy prophylaxis with fluoroquinolone (FQL) antibiotics is a recommended and accepted practice.

Increasing emergence of FQL-resistant bacteria is believed to be related to the increase in infectious complications. We sought to determine the effect of targeted antibiotic prophylaxis (TAP) before TRUSBx on infectious complications in our practice.

TAP was introduced in our practice in 2012. A retrospective analysis was performed analyzing infectious complications from TRUSBx before and after TAP was introduced. Two hundred forty-four patients underwent TRUSBx with TAP directed by bacterial antibiotic sensitivity identified on rectal swab. A group of two hundred sixty-four consecutive patients who underwent TRUSBx in our practice before introduction of TAP were chosen for comparison. Infectious complications were recorded and compared between groups. Prostate volume, PSA, number of biopsy cores, finding of prostate cancer, presence of diabetes, race and age were also compared.

The infectious complication rate after TRUSBx in the pre-TAP group was 7/264 (2. 65%), the rate in the TAP group was 1/244 (0. 41%), a statistically significant difference (P=

The use of TAP based on rectal swab testing significantly lowered our infectious complication rate for TRUSBx. TAP is now adopted as standard practice before TRUSBx in our center. The younger age and higher chance of prostate cancer on biopsy in the rectal swab group, we believe, is due to implementation of recent guidelines directing urologists be more selective in recommending prostate biopsy to older men. Prostate Cancer and Prostatic Disease advance online publication, 11 August 2015; doi:10. 1038/pcan. 2015. 38.

Prostate cancer and prostatic diseases. 2015 Aug 11 [Epub ahead of print]

I Cook, J B Angel, P L Vera, J Demos, D Preston

Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA. , Department of Urology, University of Kentucky, Lexington, KY, USA. , 1] Department of Urology, University of Kentucky, Lexington, KY, USA [2] Department of Urology, VA Medical Center, Lexington, KY, USA. , 1] Department of Urology, University of Kentucky, Lexington, KY, USA [2] Department of Urology, VA Medical Center, Lexington, KY, USA. , 1] Department of Urology, University of Kentucky, Lexington, KY, USA [2] Department of Urology, VA Medical Center, Lexington, KY, USA.

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