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. 2021 Jun;15(2):115-118.
doi: 10.1097/CU9.0000000000000013. Epub 2021 Apr 26.

Selective transperineal prostate biopsy for fluoroquinolone-resistance patients reduces sepsis and cost

Abdullah Al-Mitwalli  1 , Grigorios Kyriazis  2 , Omar El-Taji  3 , Elizabeth Chandra  2 , Wearmouth Deborah  4 , Phillipa Burns  4 , Youssef Fady  2 , Matthew Simms  2 , Smith Nicholas  2
Affiliations

Selective transperineal prostate biopsy for fluoroquinolone-resistance patients reduces sepsis and cost

Abdullah Al-Mitwalli et al. Curr Urol. 2021 Jun.

Abstract

Background: Urosepsis is a recognized complication of transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Pre-biopsy rectal swabs have been used to identify patients with microorganisms in the rectal flora resistant to the conventionally used empirical prophylaxis. The transperineal route of biopsy (TP-Bx) has a lower complication risk but comes at an increased cost.

Materials and methods: Retrospective cohort study including patients undergoing prostate biopsies between October/2015 and April/2018. The intervention cohort, a rectal swab was performed, the result of which dictated the biopsy route; TRUS-Bx against TP-Bx. TP-Bx for patients with fluoroquinolone resistance or extended-spectrum β-lactamase. The control cohort underwent TRUS without a rectal swab receiving empirical antibiotics-oral ciprofloxacin and intravenous gentamicin.

Results: Total 1000 patients were included in which 500 underwent a swab, 14 (2.8%) developed post-TRUS biopsy infective complications with 3 having positive bacteremia (0.6%); 500 had no swab, 47 (9.4%) developed post-TRUS biopsy infective complications with 22 (4.4%, p < 0.05) having positive bacteremia. Three patients (0.6%) of patients who underwent swab developed urinary tract infection symptoms whilst 12 (2.4%) had urinary tract infection in the control group. In those patients that underwent a swab, 14 required hospitalization with mean length of stay of 2.5 days versus 43 patients of the control with 3.6 days. Cost analysis concluded savings of this strategy was £18,711.

Conclusions: We have demonstrated a protocol that reserves template biopsies for higher risk patients and can significantly reduce sepsis and other infectious complication rates whilst also proving to be a cost-efficient strategy. We recommend that units not utilizing rectal swabs to uncover the fluoroquinolone resistance rate by introducing them. We advocate units that already utilize rectal swabs, to introduce transperineal biopsy for their higher risk patients.

Keywords: Prostate cancer; Rectal swab; Sepsis; Targeted antibiotic prophylaxis; Transperineal biopsy; Transrectal ultrasound-guided biopsy.

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Conflict of interest statement

No conflict of interest has been declared by the author.

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