Prophylactic antibiotic use increasing for prostate Bx

In men undergoing prostate biopsy, use of prophylactic antibiotics has been increasing appropriately over time, and fluoroquinolones still dominate, results of an insurance claims database analysis show.

There was a marked increase in regimens that incorporate parenteral administration in the analysis of private insurance claims filed between 2009 and 2015, which was presented at the 2018 American College of Surgeons clinical congress in Boston.

Although fluoroquinolones remained the most prescribed oral therapy, their usage significantly decreased over the time period evaluated, said investigator Mark Henry, MD, a urology resident with Emory University School of Medicine, Atlanta, working with Christopher P. Filson, MD, MS, and colleagues.

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“Moving forward, we hope to look to see if this is going to impact outcomes specifically with infections,” said Dr. Henry, who noted increased concerns about fluoroquinolone side effects and emerging antibiotic resistance in a podium presentation of the results.

To evaluate trends in antibiotic use for prostate biopsies, Dr. Henry and colleagues queried the Truven Health MarketScan Database for exposures to antibiotic prophylaxis. They looked in the 30-day pre-procedure window for oral antibiotics, and in the 24-hour pre-procedure window for parenteral antibiotics.

Fluoroquinolones were the most frequently used oral antibiotics, though use decreased significantly over time, from 76.8% in 2009 to 71.7% in 2015 (p<.001), Dr. Henry reported.

Use of augmented regimens increased from about 6.5% in 2009 to about 25% in 2015, he added.

Odds of receiving prophylactic antibiotics increased significantly over time, results of multivariable logistic regression analysis suggested.

Compared to 2009, the odds ratio for prophylactic antibiotics in 2010 was 1.15 (95% CI: 1.12-1.18; p<.001), increasing in a stepwise fashion for each successive year, up to an odds ratio of 3.61 (95% CI: 3.48-3.74; p<.001) in 2015, Dr. Henry reported.

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Increasing Charlson comorbidity score was also notably and significantly associated with receipt of antibiotics, Dr. Henry told meeting attendees.

AUA guidelines recommend prophylactic antibiotics for patients undergoing transrectal ultrasound-guided prostate biopsy, with fluoroquinolones and cephalosporins as the first-line choice, Dr. Henry noted.

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“However, there is a growing concern for the side effects of fluoroquinolones, as well as the potential resistance of E. coli, which is the main target of these antibiotics,” he said.

In parallel, there’s been increasing support and interest in augmented regimens that utilize intravenous or intramuscular antibiotics as well at the time of prostatectomy, he said.

That’s why the authors sought to evaluate trends over time in both fluoroquinolone use and parenteral antibiotics using this insurance database, he told attendees