Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic prophylaxis

Mehrad Adibi, Brad Hornberger, Deepa Bhat, Ganesh Raj, Claus Roehrborn, Yair Lotan

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Purpose: We evaluated the incidence of infectious complications requiring hospitalization after transrectal ultrasound guided prostate biopsy, comparing an augmented regimen of antibiotic prophylaxis to the standard regimen, and established cost-effectiveness at our center. Materials and Methods: Our standard antibiotic prophylaxis regimen consisted of 3 days of ciprofloxacin or Bactrim™ DS in the perioperative period. An increase in hospital admissions related to infection after transrectal ultrasound guided biopsy from January 2010 through December 2010 led us to initiate an augmented regimen of 3 days of ciprofloxacin or Bactrim DS in addition to 1 dose of intramuscular gentamicin before biopsy from January 2011 to December 2011. Urine and blood cultures along with bacterial susceptibilities were obtained at admission and compared between the 2 groups. Cost analysis was done to determine the cost-effectiveness of standard and augmented regimens. Results: The rate of hospitalization due to post-biopsy infections was 3.8% (11 patients among 290 biopsies) in 2010, which decreased to 0.6% (2 patients among 310 biopsies) in 2011 (p <0.001). Of the admitted patients who received standard prophylaxis, 73% had fluoroquinolone resistant Escherichia coli urinary infection and/or bacteremia and only 9% had strains resistant to gentamicin. Multivariate analysis showed that the standard regimen was significantly associated with hospital admission due to post-biopsy infection (HR 2.078 ± 0.84, p = 0.013). The augmented regimen resulted in a cost savings of $15,700 per 100 patients compared to the standard regimen. Conclusions: The addition of gentamicin to current prophylactic regimens significantly reduced the rate of hospitalization for post-biopsy infectious complications and was shown to be cost-effective.

Original languageEnglish (US)
Pages (from-to)535-540
Number of pages6
JournalJournal of Urology
Volume189
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Antibiotic Prophylaxis
Prostate
Biopsy
Infection
Gentamicins
Hospitalization
Sulfamethoxazole Drug Combination Trimethoprim
Ciprofloxacin
Cost-Benefit Analysis
Costs and Cost Analysis
Escherichia coli Infections
Perioperative Period
Cost Savings
Fluoroquinolones
Bacteremia
Multivariate Analysis
Urine
Incidence

Keywords

  • antibiotic prophylaxis
  • biopsy
  • infection
  • prostate

ASJC Scopus subject areas

  • Urology

Cite this

Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic prophylaxis. / Adibi, Mehrad; Hornberger, Brad; Bhat, Deepa; Raj, Ganesh; Roehrborn, Claus; Lotan, Yair.

In: Journal of Urology, Vol. 189, No. 2, 02.2013, p. 535-540.

Research output: Contribution to journalArticle

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abstract = "Purpose: We evaluated the incidence of infectious complications requiring hospitalization after transrectal ultrasound guided prostate biopsy, comparing an augmented regimen of antibiotic prophylaxis to the standard regimen, and established cost-effectiveness at our center. Materials and Methods: Our standard antibiotic prophylaxis regimen consisted of 3 days of ciprofloxacin or Bactrim™ DS in the perioperative period. An increase in hospital admissions related to infection after transrectal ultrasound guided biopsy from January 2010 through December 2010 led us to initiate an augmented regimen of 3 days of ciprofloxacin or Bactrim DS in addition to 1 dose of intramuscular gentamicin before biopsy from January 2011 to December 2011. Urine and blood cultures along with bacterial susceptibilities were obtained at admission and compared between the 2 groups. Cost analysis was done to determine the cost-effectiveness of standard and augmented regimens. Results: The rate of hospitalization due to post-biopsy infections was 3.8{\%} (11 patients among 290 biopsies) in 2010, which decreased to 0.6{\%} (2 patients among 310 biopsies) in 2011 (p <0.001). Of the admitted patients who received standard prophylaxis, 73{\%} had fluoroquinolone resistant Escherichia coli urinary infection and/or bacteremia and only 9{\%} had strains resistant to gentamicin. Multivariate analysis showed that the standard regimen was significantly associated with hospital admission due to post-biopsy infection (HR 2.078 ± 0.84, p = 0.013). The augmented regimen resulted in a cost savings of $15,700 per 100 patients compared to the standard regimen. Conclusions: The addition of gentamicin to current prophylactic regimens significantly reduced the rate of hospitalization for post-biopsy infectious complications and was shown to be cost-effective.",
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