Targeted Prophylaxis Cuts Infection Costs After Transrectal Prostate Biopsy

March 02, 2012

NEW YORK (Reuters Health) Mar 01 - Antibiotic prophylaxis based on rectal swab cultures in men undergoing transrectal ultrasound-guided prostate biopsies (TRUSP) might reduce post-procedure infections, and it saves money, a new study shows.

"The impetus for our study was the increasing incidence of infectious complications caused by FQ (fluoroquinolone) resistant organisms among men undergoing TRUSP," the researchers wrote in a paper online in the Journal of Urology.

Dr. Anthony J. Schaeffer, at Northwestern University Feinberg School of Medicine in Chicago, Illinois, and colleagues suspected they might reduce this problem by using targeted antimicrobial prophylaxis based on rectal swab cultures rather than empirical fluoroquinolone prophylaxis.

To investigate, the team looked at rates of infection within 30 days after TRUSP in 457 men, 25% of whom had a rectal swab culture about a week before the procedure. Selection for culturing was done "at the discretion of the treating urologists whose preference and comfort with this newly introduced process likely dictated their choices," according to the paper.

Among the 112 men in the cultured group, 22 (19.6%) had fluoroquinolone-resistant organism and they received directed antibiotic prophylaxis, while the others received ciprofloxacin. Standard empirical ciprofloxacin was given to the 345 who did not have a rectal swab culture.

There were no infectious complications in the group receiving targeted antibiotic prophylaxis compared with 9 cases (2.6%) in the empirical group (p=0.12), the investigators found.

They went on to calculate that the total cost of targeted versus empirical therapy per 100 men, including the costs of managing infectious complications, was $1,346 versus $5,598, respectively. The number-needed-to-treat to avert one infectious complication was 38, and the cost-saving per case averted was $4,499.

The authors caution that the antibiotics they used in patients harboring fluoroquinolone-resistant organisms are not all included in current guidelines.

"The optimal drug, dose, duration and route of administration of antimicrobial prophylaxis for patients with bowel colonization with FQ resistant bacteria remain unresolved issues that are best addressed in a prospective randomized trial," Dr. Schaeffer and colleagues conclude. "As more urological patients' bowel flora become FQ resistant, such a trial may become more clinically relevant and important."


J Urol 2012;187:1275-1279.