Rebecca S Steinberg1, Lauren Kipling2, K C Biebighauser Bens1, Dattatraya Patil1, Mark Henry1, Akanksha Mehta1, Christopher Filson3,4. 1. Department of Urology, Emory University School of Medicine, Atlanta, GA, USA. 2. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. 3. Department of Urology, Emory University School of Medicine, Atlanta, GA, USA. cfilson@emory.edu. 4. Winship Cancer Institute, Emory Healthcare, Atlanta, GA, USA. cfilson@emory.edu.
Abstract
PURPOSE: Sepsis after prostate biopsy is a costly and potentially lethal complication. We sought to assess whether enhanced antibiotic prophylaxis regimens combining oral and parenteral antibiotics may decrease the risk of post-biopsy urinary tract infection and sepsis compared to regimens with only oral antibiotics. METHODS: We identified men with commercial insurance who underwent prostate biopsy (2009-2015) with prophylactic antibiotic coverage. Our primary exposure of interest was antibiotic regimen: enhanced, oral-only, and parenteral-only. Post-biopsy outcomes of interest included urinary tract infections and sepsis/bacteremia after prostate biopsy. We used bivariate testing to assess associations between outcomes, exposures, and other covariates of interest. Multivariable regression was used to estimate adjusted odds of infectious outcomes based on antibiotic regimen. RESULTS: We identified 163,831 men who underwent prostate biopsy. The proportion of men with infectious complications (5.5% in 2009 to 6.9% in 2015, p < 0.001) and sepsis (0.24% in 2009 to 0.30% in 2015, p = 0.327) increased over the timeframe of our analysis. Use of fluoroquinolones was associated with a decreased risk of infectious outcomes (5.8 vs 7.3% without, OR 0.83, 95% CI 0.79-0.88). Use of enhanced antibiotic regimens was associated with an increased risk of infectious outcomes (6.8 vs 5.7% oral, OR 1.23, 95% CI 1.16-1.31) and sepsis (0.34 vs 0.24% oral, OR 1.40, 95% CI 1.08-1.82) among our cohort. CONCLUSION: We did not observe a significant reduction in infectious complications among men who received enhanced antibiotics regimens before prostate biopsy. This may be due to increased antibiotic resistance or unmeasured risk factors among those receiving enhanced regimens.
PURPOSE: Sepsis after prostate biopsy is a costly and potentially lethal complication. We sought to assess whether enhanced antibiotic prophylaxis regimens combining oral and parenteral antibiotics may decrease the risk of post-biopsy urinary tract infection and sepsis compared to regimens with only oral antibiotics. METHODS: We identified men with commercial insurance who underwent prostate biopsy (2009-2015) with prophylactic antibiotic coverage. Our primary exposure of interest was antibiotic regimen: enhanced, oral-only, and parenteral-only. Post-biopsy outcomes of interest included urinary tract infections and sepsis/bacteremia after prostate biopsy. We used bivariate testing to assess associations between outcomes, exposures, and other covariates of interest. Multivariable regression was used to estimate adjusted odds of infectious outcomes based on antibiotic regimen. RESULTS: We identified 163,831 men who underwent prostate biopsy. The proportion of men with infectious complications (5.5% in 2009 to 6.9% in 2015, p < 0.001) and sepsis (0.24% in 2009 to 0.30% in 2015, p = 0.327) increased over the timeframe of our analysis. Use of fluoroquinolones was associated with a decreased risk of infectious outcomes (5.8 vs 7.3% without, OR 0.83, 95% CI 0.79-0.88). Use of enhanced antibiotic regimens was associated with an increased risk of infectious outcomes (6.8 vs 5.7% oral, OR 1.23, 95% CI 1.16-1.31) and sepsis (0.34 vs 0.24% oral, OR 1.40, 95% CI 1.08-1.82) among our cohort. CONCLUSION: We did not observe a significant reduction in infectious complications among men who received enhanced antibiotics regimens before prostate biopsy. This may be due to increased antibiotic resistance or unmeasured risk factors among those receiving enhanced regimens.
Authors: Michael D Gross; Mark N Alshak; Jonathan E Shoag; Aaron A Laviana; Michael A Gorin; Art Sedrakyan; Jim C Hu Journal: Urology Date: 2019-06-21 Impact factor: 2.649
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Authors: Nicolas Mottet; Roderick C N van den Bergh; Erik Briers; Thomas Van den Broeck; Marcus G Cumberbatch; Maria De Santis; Stefano Fanti; Nicola Fossati; Giorgio Gandaglia; Silke Gillessen; Nikos Grivas; Jeremy Grummet; Ann M Henry; Theodorus H van der Kwast; Thomas B Lam; Michael Lardas; Matthew Liew; Malcolm D Mason; Lisa Moris; Daniela E Oprea-Lager; Henk G van der Poel; Olivier Rouvière; Ivo G Schoots; Derya Tilki; Thomas Wiegel; Peter-Paul M Willemse; Philip Cornford Journal: Eur Urol Date: 2020-11-07 Impact factor: 20.096