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Authors: Ni Bhuachalla C 1 , McNamara E 2 , Carroll A 2 , Lynch T 1 , Boyle B 1

Increasing transrectal ultrasound guided prostate biopsy associated infection; is a change in antimicrobial prophylaxis the solution?. Authors: Ni Bhuachalla C 1 , McNamara E 2 , Carroll A 2 , Lynch T 1 , Boyle B 1

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Authors: Ni Bhuachalla C 1 , McNamara E 2 , Carroll A 2 , Lynch T 1 , Boyle B 1

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  1. Increasing transrectal ultrasound guided prostate biopsy associated infection; is a change in antimicrobial prophylaxis the solution? Authors: Ni Bhuachalla C1, McNamara E2, Carroll A2, Lynch T1, Boyle B1 1. St James’s Hospital, Dublin 8, Ireland. 2. Public Health Laboratory HSE, Dublin 10, Ireland.

  2. TRUS biopsy associated infection • Surveillance/ diagnostic protocol • Post procedure infection rates • 1- 3% UTI • 0 .5- 1% BSI • Strategies to reduce rate of infection • Antimicrobial prophylaxis • Pre procedure screening • Decontamination protocol • Operator training

  3. Antimicrobial prophylaxis

  4. “...clear lack of standardization in antibiotic prophylaxis for transrectal prostate biopsy...” “...in nine trials we observed that antibiotic prophylaxis is effective in preventing infectious complicationsand hospitalization following prostate biopsy...” “...several classes of antibiotics are effective for prophylaxis in prostate biopsy, with the quinolones the best analysed class...”

  5. Antimicrobial resistance •  prevalence fluoroquinolone (FQ) resistance •  prevalence gentamicin resistance • Previous exposure to antimicrobials • Previous health care contact

  6. E. coli BSI Resistance in Ireland (EARSS) 2004 - 2012

  7. E. coli BSI resistance St James’s Hospital 2009 - 2012 % Resistance

  8. Aims • To identify all patients with post TRUS biopsy infection from Jan 2010 - Nov 2012 • Review isolates and susceptibilities causing infection • Review antimicrobial prophylaxis administered • To assess efficacy of change in prophylaxis from Dec 2012 to date

  9. Study period 1 (Retrospective) Jan 2010 – Nov 2012 Prophylaxis gentamicin and FQ ID and susceptibility testing Vitek 2 Typed by PFGE (pulse net protocol) Study period 2 (Prospective) Dec 2012 – Feb 2013 Prophylaxis amikacin and FQ Methods

  10. Study period 1Jan 2010 – Nov 2012

  11. Number of TRUS associated infections Jan 2010- Nov 2012 (2.5%) (0.2%) (until end of Nov 2012)

  12. Study period 1Jan 2010 – Nov 2012PFGE • 6 available isolates - distinguishable

  13. Study period 2Dec 2012 – Feb 2013

  14. Post TRUS infection rate Jan 2010 to date Change of prophylaxis 2.5% 2% 0.2%

  15. Local interim Recommendations • Amikacin and FQ? • Avoid fluoroquinolone use in empiric treatment of post biopsy infection • Targeted treatment of post biopsy infection when susceptibilities available • Targeted prophylaxis?

  16. Conclusions • Increase in TRUS biopsy associated infection • Increasing antimicrobial resistance • Prospective surveillance • Potentially multifactorial process

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