Targeted prophylaxis shows promise in addressing post-TRUSP infections

In men undergoing transrectal ultrasound-guided prostate biopsy (TRUSP), targeted antimicrobial prophylaxis based on findings from rectal swab cultures significantly reduces the incidence of infectious complications and has implications for decreasing the overall cost of care, according to data reported by researchers from Northwestern University, Chicago.

The effectiveness of targeted antimicrobial prophylaxis was evaluated in a study that included 451 men who underwent TRUSP between July 2010 and March 2011. Rectal swabs were obtained for culture and sensitivity testing from 117 patients at risk for colonization with fluoroquinolone-resistant organisms. Twenty-four of the 117 men (20.5%) had positive cultures for quinolone-resistant organisms and were treated with targeted antmicrobial prophylaxis based on the microbiological results. All 24 men were compliant with their targeted antimicrobial prophylaxis, which in the majority of cases involved an oral cephalosporin or trimethoprim-sulfamethoxazole (Bactrim, Septra DS).

The remaining subgroup of 334 men, which included those with and without risk factors for quinolone-resistant bacteria, received standard empiric prophylaxis comprised of a Fleet enema with two oral doses of ciprofloxacin (Cipro, Proquin XR), the first given 2 hours prior to TRUSP and the second 12 hours after the procedure.

Infectious complications after TRUSP were absent among the men who received targeted antimicrobial prophylaxis but developed in eight (2.4%) of the 334 patients who had empiric prophylaxis. Of the eight patients, seven had infections due to a quinolone-resistant pathogen, including one patient with sepsis, reported first author Aisha Taylor, MD, who worked on the study with Anthony Schaeffer, MD, and colleagues.

"Not only do we think targeted antimicrobial prophylaxis is an effective strategy to reduce infectious complications after TRUSP, but we believe this low-cost screening method can also significantly reduce cost of care. According to an analysis we conducted that included cost for the rectal swab and alternative antibiotic treatment using the most expensive intramuscular medication administered, the cost for treating 100 men undergoing TRUSP was calculated as $1,323 using the targeted approach versus $5,066 for empiric prophylaxis," Dr. Taylor said.

"Although rare, serious infectious complications after TRUSP are an important problem, and we believe the use of targeted antimicrobial prophylaxis using rectal swab cultures warrants further investigation in a larger, multi-institutional study."