Preventing Prostate Biopsy Complications: to Augment or to Swab?

Autor: Glick L; Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA., Vincent SA; Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA., Squadron D; Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA., Han TM; Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA., Syed K; Health Care Improvement Foundation, Philadelphia, PA., Danella JF; Department of Urology, Geisinger Medical Center, Danville, PA., Ginzburg S; Department of Urology, Einstein Healthcare Network, Philadelphia, PA., Guzzo TJ; Division of Urology, University of Pennsylvania, Philadelphia, PA., Lanchoney T; Urology Health Specialists, Hershey, PA., Raman JD; Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA., Smaldone M; Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA., Uzzo RG; Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA., Tomaszweski JJ; Division of Urology, Cooper University, Camden, NJ., Reese A; Department of Urology, Temple University, Philadelphia, PA., Singer EA; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ., Jacobs B; Department of Urology, University of Pittsburgh Medical Center, Pittsburg, PA., Trabulsi EJ; Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA., Gomella LG; Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA., Mann MJ; Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Electronic address: mark.mann@jefferson.edu.
Jazyk: angličtina
Zdroj: Urology [Urology] 2021 Sep; Vol. 155, pp. 12-19. Date of Electronic Publication: 2021 Apr 18.
DOI: 10.1016/j.urology.2021.02.043
Abstrakt: Objective: To use data from a large, prospectively- acquired regional collaborative database to compare the risk of infectious complications associated with three American Urologic Association- recommended antibiotic prophylaxis pathways, including culture-directed or augmented antibiotics, following prostate biopsy.
Methods: Data on prostate biopsies and outcomes were collected from the Pennsylvania Urologic Regional Collaborative, a regional quality collaborative working to improve the diagnosis and treatment of prostate cancer. Patients were categorized as receiving one of three prophylaxis pathways: culture-directed, augmented, or provider-discretion. Infectious complications included fever, urinary tract infections or sepsis within one month of biopsy. Odds ratios of infectious complication by pathway were determined, and univariate and multivariate analyses of patient and biopsy characteristics were performed.
Results: 11,940 biopsies were included, 120 of which resulted in infectious outcomes. Of the total biopsies, 3246 used "culture-directed", 1446 used "augmented" and 7207 used "provider-discretion" prophylaxis. Compared to provider-discretion, the culture-directed pathway had 84% less chance of any infectious outcome (OR= 0.159, 95% CI = [0.074, 0.344], P < 0.001). There was no difference in infectious complications between augmented and provider-discretion pathways.
Conclusions: The culture-directed pathway for transrectal prostate biopsy resulted in significantly fewer infectious complications compared to other prophylaxis strategies. Tailoring antibiotics addresses antibiotic-resistant bacteria and reduces future risk of resistance. These findings make a strong case for incorporating culture-directed antibiotic prophylaxis into clinical practice guidelines to reduce infection following prostate biopsies.
(Copyright © 2021. Published by Elsevier Inc.)
Databáze: MEDLINE
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