A Switch From Transrectal Biopsy To Cognitive Freehand Transperineal Prostate Biopsy Can Reduce Sepsis Where Targeted Antibiotics For Resistant Rectal Flora Have Failed

You have accessJournal of UrologyProstate Cancer: Detection & Screening VIII (MP81)1 Apr 2020MP81-18 A SWITCH FROM TRANSRECTAL BIOPSY TO COGNITIVE FREEHAND TRANSPERINEAL PROSTATE BIOPSY CAN REDUCE SEPSIS WHERE TARGETED ANTIBIOTICS FOR RESISTANT RECTAL FLORA HAVE FAILED Luke Stroman*, Tom Newman, Marios Hadjipavlou, Demetris Ioannides, Caitlin Milliken, Tibor Pinczes, Jonah Rusere, Nick Mehan, Ella Di Benedetto, Dharmesh Patel, Rick Popert, and Mohamed Hammadeh Luke Stroman*Luke Stroman* More articles by this author , Tom NewmanTom Newman More articles by this author , Marios HadjipavlouMarios Hadjipavlou More articles by this author , Demetris IoannidesDemetris Ioannides More articles by this author , Caitlin MillikenCaitlin Milliken More articles by this author , Tibor PinczesTibor Pinczes More articles by this author , Jonah RusereJonah Rusere More articles by this author , Nick MehanNick Mehan More articles by this author , Ella Di BenedettoElla Di Benedetto More articles by this author , Dharmesh PatelDharmesh Patel More articles by this author , Rick PopertRick Popert More articles by this author , and Mohamed HammadehMohamed Hammadeh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000973.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transrectal prostate biopsy (TRUSBx) holds a significant risk of sepsis and resistant rectal flora can increase risk further. We aimed to target antibiotics at patients with known resistant flora undergoing TRUSBx. Following this we then aimed to reduce sepsis by switching to cognitive freehand transperineal biopsy (FTPBx) using the PrecisionPoint™ (TP) access system, primarily under local anesthetic. METHODS: 1,227 patients were included in a 3-cycle cohort study from January 2014 - March 2019 in a district general hospital in London. Group A (609 patients) underwent TRUSBx and received empirical antibiotics. Group B (403 patients) underwent TRUSBx with targeted antibiotics, rationalised with rectal swab microscopy, culture and sensitivity. Group C (215 patients) underwent FTPBx and received either oral co-amoxiclav or clindamycin. Data was collected retrospectively from hospital and primary care electronic documentation. Sepsis rates between group were analysed using Fisher’s exact test. RESULTS: Group A had 12/209 (2.0%) cases of sepsis. Targeting antibiotics following resistant bacteria on rectal swabs failed to reduce sepsis in group B (9/403, 2.2%) when compared to A (p = 0.82). In Group B, patients with ciprofloxacin-resistant rectal flora had a higher rate of sepsis (9.1% vs 1.1%, p = 0.003). There were no cases of sepsis in cases using FTPBx (0/215). FTPBx reduced sepsis rates when compared to TRUSBx (C vs B, 0 vs 2.0%, p = 0.04; C vs A, 0 vs 2.2%, p = 0.03). CONCLUSIONS: Ciprofloxacin resistant bacteria increased the risk of sepsis following TRUSBx in our cohort. Switching antibiotics to target resistant bacteria did not reduce sepsis but a switch to FTPBx did. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1243-e1243 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luke Stroman* More articles by this author Tom Newman More articles by this author Marios Hadjipavlou More articles by this author Demetris Ioannides More articles by this author Caitlin Milliken More articles by this author Tibor Pinczes More articles by this author Jonah Rusere More articles by this author Nick Mehan More articles by this author Ella Di Benedetto More articles by this author Dharmesh Patel More articles by this author Rick Popert More articles by this author Mohamed Hammadeh More articles by this author Expand All Advertisement PDF downloadLoading ...