Presentation Authors: Alexandre Morin*, Sherbrooke, Canada, Marco Bergevin, Nathalie Rivest, Laval, Canada, Steven P Lapointe, Mont-Royal, Canada
Introduction: Fluoroquinolones are recommended as first line antibioprophylaxis (ATBPx) for transrectal ultrasound-guided prostate needle biopsy (PNB). Recent studies report rising rates of post-PNB infections associated with emergent fluoroquinolone resistant E. coli, urging re-evalutation of ATBPx. The objective of this study was to compare rates of post-PNB sepsis associated with 2 oral regimens of ATBPx: a single dose of ciprofloxacin 500 mg (CIP) vs single dose of ciprofloxacin 500 mg and fosfomycin 3 g combination (CIP/FOS).
Methods: We performed a retrospective, pre-post intervention study on all patients who underwent PNB in 2 Canadian hospitals from January 2012 to December 2015. ATBPx was changed from CIP to CIP/FOS in December 2013. ATBPx was administered two hours prior to PNB, along with a sodium phosphate enema. Patient charts were reviewed for hospital visits, microbiologic results, and 14 recognized risk factors for post-PNB infectious complications. The primary outcome was urosepsis within 1 month of PNB. Sepsis rates, according to ATBPx regimens, were analyzed using log-binomial regression considering the propensity scores weights of collected risk factor data.
Results: We reviewed charts of 2287 patients, including 1090 who received CIP alone and 1197 who received CIP/FOS. Urosepsis incidence with CIP alone was 1.1% (12/1090) and fell to 0.2% (2/1197) with CIP/FOS. Our analysis indicates that CIP/FOS significantly decreased the risk of sepsis compared to CIP alone (aRR = 0.16; p = 0.021). The pathogen was E. coli in 12/14 cases, with 7 CIP resistant strains. Most E. coli (11/12) were from CIP alone group. We observed 7 cases of E. coli bacteremia, with 5/7 blood cultures showing CIP resistant strains. One case of B. fragilis septicemia occurred in the CIP/FOS group. No cases of C. difficile diarrhea were identified within the 3 months post-PNB.
Conclusions: The use of CIP/FOS prophylaxis in PNB significantly lowered our rates of post-procedural sepsis. Conveniently, this regimen is oral and obviates the need for rectal swab screening. Further prospective studies should be performed before widespread use of this antibioprophylaxis regimen.
Source of Funding: AbbVie unrestricted educational grant