Poster, Podium & Video Sessions
Presentation Authors: Alexander Van Hoof, Nedim Ruhotina MD, Sarah Faisal, Bashar Omarbasha MD, Christopher Pieczonka MD, Yi Yang MD, David Albala MD*, Syracuse, NY
Introduction: Trans-Rectal Ultrasound guided prostate biopsy (TRUSBX) and fiducial marker placement (TRUSFM) are noted sources of infectious complications. While data describing the risk of post-TRUSFM infection are lacking, there is an abundance of evidence describing the increasing rate of post-TRUSBX infectious complications. Particularly significant is the rising incidence of more serious infections such as Sepsis and UTIs, which are associated with a high degree of morbidity and cost. Recent evidence links this to a concomitant rise in prevalence of flouroquinolone resistant (FQR) organisms and suggests that use of empirical prophylaxis needs reevaluation. This study aims to make a case for adopting a Rectal Swab (RS) guided prophylaxis by showcasing the effectiveness and feasibility of implementing such a protocol in a large private practice with multiple locations. Additionally, we will be able to better describe the risk of infection associated with TRUSFM.
Methods: From January 1st, 2011 through May, 30th 2015 we observed the difference in rates of infectious sequelae post-TRUSBX and post-TRUSFM in men who received RS-guided prophylaxis vs empirical prophylaxis with fluoroquinolones per AUA guidelines. RS specimens were collected from patients using a BBL culture swab and plated on selective media containing ciprofloxacin to identify FQR. Standard FQ prophylaxis was prescribed to patients showing FQ sensitivity and patients with cultures positive for FQR organisms received targeted prophylaxis based on further susceptibility testing.
Results: 5,084 men underwent 1,106 TRUSFM and 5,843 TRUSBX. The prophylactic regimen was prescribed empirically for 2,296 TRUSBXs and 404 TRUSFMs; of these 83 (3.61%) and 21 (5.20%) resulted in infectious complications respectively. A RS-guided prophylactic regimen was used for 3,547 TRUSBXs and 707 TRUSFMs; of these 27 (0.76%) and 7 (1.00%) resulted in infection. 4,248 RS were performed and cultured on 3,294 men. Of these, 472 (11.2%) of the rectal swabs were positive, and 393 men (11.9%) were found to have at least one FQR organism. Of the FQR organisms identified (96.27% being E. coli) 83.7% were multidrug resistant and 37.5% possessed co-resistances to at least 5 other antimicrobials. Co-resistance rates for specific antimicrobials were as high as 70% (Ampicillin).
Conclusions: The considerably lower infection rates observed in men receiving RS guided prophylaxis along with the significant prevalence of FQR displays the advantage of adopting the practice of a rectal swab program. Additionally, the high prevalence of multidrug resistance suggests that alternative methods such as augmented or multi-drug prophylaxis regimens that are commonly empirically prescribed would likely have limited success.
Source Of Funding: none
Dr. David M. Albala graduated with a geology degree from Lafayette College in Easton, Pennsylvania. He completed his medical school training at Michigan State University and went on to complete his surgical residency at the Dartmouth-Hitchcock Medical Center. Following this, Dr. Albala was an endourology fellow at Washington University Medical Center under the direction of Ralph V. Clayman. He practiced at Loyola University Medical Center in Chicago and rose from the ranks of Instructor to full Professor in Urology and Radiology in eight years. After 10 years at Loyola University, he became a tenured Professor at Duke University Medical Center in North Carolina. At Duke, he was Co-Director of the Endourology fellowship and Director for the Center of Minimally Invasive and Robotic Urological Surgery. He has over 180 publications in peer-reviewed journals and has authored three textbooks in endourology and one in general urology. He is the Editor-in-Chief of the Journal of Robotic Surgery.
At the present time he is Chief of Urology at Crouse Hospital in Syracuse, New York and Medical Director for Associated Medical Professionals (a group of 29 urologists). He is considered a national and international authority in laparoscopic and robotic urological surgery and has been an active teacher in this area for over 20 years. His research and clinical interests have focused on robotic urological surgery and biomarkers used in Prostate cancer. In addition, other clinical interests include minimally invasive treatment of benign prostatic hypertrophy (BPH) and the use of fibrin sealants in surgery. He has been a Visiting Professor at numerous institutions across the United States as well as overseas.
In addition, Dr. Albala is a past White House Fellow who acted as a special assistant to Federico Pena, Secretary of Transportation, on classified and unclassified public health related issues.
Monday, May 15
7:30 AM – 9:30 AM