Presentation Authors: Adrian Sosenko*, Thomas Lanchoney, Hershey, PA, Thomas Guzzo, Edouard Trabulsi, Philadelphia, PA, John Danella, Heshey, PA, Mark Mann, Adam Reese, Philadelphia, PA, Jeffrey Tomaszewski, Hershey, PA, Serge Ginzburg, Philadelphia, PA, Robert Uzzo, Marc Smaldone, Claudette Fonshell, Bret Marlowe, Jay Raman, Adrian Sosenko, Hershey, PA
Introduction: Transrectal ultrasound guided prostate needle biopsy (TRUS PNB) is associated with infectious complications due to antibiotic resistant organisms. Prophylaxis regimens have evolved to prevent such infections although lack of standardization and heterogeneity may compound this issue further. We review antibiotic prophylaxis practice patterns for TRUS PNB with a focus on the extent of heterogeneity and consolidation of regimens following a physician champion effort.
Methods: The Pennsylvania Urologic Regional Collaboration (PURC) is a physician-led quality collaborative established in 2015 with 9 participating practices encompassing 108 urologists. Amongst biopsies performed from 2015-2017, 5379 had documentation of prophylactic antibiotic regimen and formed the cohort of analysis. Overall number and distribution of antibiotic regimens were determined. Quarterly trends in the number of unique antibiotic regimens were noted.
Results: Of the 5379 TRUS PNB cases, 4147 (77%) utilized a single agent, 1197 (22%) used dual augmented therapy, and 35(1%) incorporated three or more antibiotics for prophylaxis. To date, 88 unique antibiotic regimens were used for prophylaxis with the 10 most common noted in Figure 1. Ciprofloxacin (n=2609, 48%) and Ceftriaxone (n=2268, 42%) were most often used either alone or in combination with other agents. The number of unique antibiotic combinations increased quarterly from Q2 2015 (n=18 regimens) to Q2 2017 (n=40 regimens). A physician champion led effort to standardize regimens based on guidelines and local antibiograms resulted in a 43% reduction in unique regimens (Q4 2017; n=23 regimens). (Figure 2)
Conclusions: Significant variability exists with respect to prophylactic antibiotic regimens across providers in PURC. However, proactive guidelines based education was successful in consolidating protocols. Future evaluation is requisite to determine sustainability of such efforts.