Presentation Authors: Duncan Self*, Ashe DeBiasio, Weranja Ranasinghe, Mark Louie-Johnsun, Hugh Finlay Macneil, Rupert Ouyang, Stephen Ruthven, Gosford, Australia
Introduction: Ultrasound guided prostate biopsy remains the gold standard for prostate cancer diagnosis. Current literature identifies increasing incidence of fluoroquinolone resistant Escherichia Coli (QREC). We aim to evaluate the use of rectal swabs in management of QREC in patients undergoing transrectal ultrasound guided biopsy (TRUSBx) & itâ€™s cost effectiveness.
Methods: A retrospective study was performed on all men who underwent TRUSBx from 2012 to 2018 within the Central Coast, New South Wales, Australia. A majority of urologists performed rectal swab pre-TRUSBx. All patients received ciprofloxacin prophylaxis except when QREC was identified, where either transperineal prostate biopsy or meropenem prophylaxis were offered. Results were compared against a contemporary study conducted in Victoria, Australia (Leahy, et al.) where ciprofloxacin prophylaxis was used with ertapenem used on anecdotal basis & no rectal swabs performed.Sepsis rates, incidence of QREC & cost effectiveness of routine rectal swab were assessed. Fisherâ€™s exact test was used for statistical analysis.
Results: 1668 men underwent TRUSBx; 563 (34%) had pre-TRUSBx rectal swab. Mean age was 67 & mean number of cores taken was 17 (range 2-42). The comparison study included 1977 patients without rectal swab, mean cores of 17 (range 10-22) & age was not reported.QREC positive rectal swabs were found in 23 men (4.07%): 20 received meropenem prophylaxis; 3 inadvertently received ciprofloxacin & were excluded due to not meeting standard treatment protocol.17 patients developed sepsis, significantly lower than the comparison study (1.02% vs 3.18% p < 0.01); 4 having QREC bacteraemia, significantly lower than the comparison (4/1668 vs 23/1977; p < 0.01). There were no cases of sepsis amongst patients with QREC on rectal swab given meropenem prophylaxis, mirroring the comparison with no sepsis in patients given ertapenem.24 rectal swabs were needed to identify 1 patient with QREC positivity, total cost of $3216. The mean cost per sepsis admission was $7819 suggesting routine rectal swab as a cost-effective strategy enabling targeted antibioprophylaxis.
Conclusions: In this study, overall TRUSBx sepsis rates are lower than those in comparable literature. Rectal swab resulted in a change of practice guiding targeted antibioprophylaxis with zero incidence of sepsis in this group. We hypothesise that rectal swab contributed to our low sepsis rates & can be considered cost-effective practice to minimise preventable sepsis in patients undergoing TRUSBx.