Transrectal Ultrasound Guided Prostate Biopsy

Project: Research project

Project Details

Description

Prostate Cancer, the second most common cause of cancer death among US males only behind lung cancer, is diagnosed by prostate biopsy. Approximately 800,000 prostate biopsies are performed annually, and transrectal ultrasound guided prostate biopsy (TRUSP) is by far the most commonly used procedure. Despite the fact that TRUSP is generally considered a safe procedure, breakthrough infections with drug-resistant bacteria following TRUSP are increasing, in part due to failure of standard empiric antibiotic prophylaxis regimens.

For many years, fluoroquinolones (FQs) were given prior to TRUSP as empiric prophylaxis by approximately 90% of urologists because of their broad spectrum, favorable pharmacokinetics, and ease of oral administration. However in recent years, many investigators have noted a significant rist not only in FQ-resistant but also multidrug-resistant (MDR) bacterial infections following TRUSP, likely due to an increasing percentage of patients harboring drug-resistant bacteria in their fecal flora. This has led urologists to consider expanding and has led the American Urological Association (AUA) in 2011 to advise urologists to consider expanding antibiotic prophylaxis in certain patients and to initiate broad spectrum antibiotic therapy in patients who present with infections following TRUPS. To date, though, specific risk factors for drug-resistant infections and alternative prophylaxis regimens have not been well defined. In the absence of data, some urologists are proposing use of empiric antibiotic regimens that contain broader spectrum antibiotics or antibiotic combinations to combat this problem. While this approach may work temporarily, we are concerned that it runs the risk of driving further antimicrobial resistance. At Northwestern University (NU), we have devised a different strategy.

As part of a quality improvement initiative (QII) at our institution from July 2010 to March 2011, urologists used either standard empiric prophylaxis or targeted antimicrobial prophylaxis in patients undergoing TRUPS at their discretion. Standard empiric prophylaxis included an oral dose of ciprofloxacin 2 hours prior to and 12 hours after the procedure, while targeted prophylaxis was patient-specific and was based on rectal swab cultures obtained prior to TRUPS. We identified men with infections complications within 30 days post-TRUPS using our electronic medical record and found that targeted antimicrobial prophylaxis significantly reduced the incidence of post-TRUPS infectious complications and decreased the overall cost of care. A larger prospective study is necessary to determine whether a targeted approach to TRUPS prophylaxis is warranted.

Dr. Anthony Schaeffer, MD (Urology, study PI) with other investigators from NU (Dr. Robert Nadler, MD Urology). Dr. Teresa Zembower MD, MPH (Infectious Disease) and Dr. John Cashy PhD (Biostatistics) will lead a multi-institutional prospective, non-randomized trial to evaluate the efficacy of a directed approach for pre-operative antibiotic prophylaxis for TRUPS. As part of the study, all study participants will undergo a rectal swab culture prior to TRUSP, and antibiotics prophylaxis regimens will be based on results. The primary purpose of the study is to compare rates of the infections following TRUPS in patients who do not harbor FQ resistant bacteria and receive FQ prophylaxis (the gold standard) with patients who harbor FQ resistant bacteria and receive alternative therapy targeted to their culture results. Additional study goals are to determine the risk factors for inf
StatusFinished
Effective start/end date7/1/124/30/16

Funding

  • Northwestern Memorial Hospital (EAM 237)
  • Illinois Department of Healthcare and Family Services (EAM 237)

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