Introduction: Prostate biopsy is the gold standard for diagnosing prostate cancer, but post-biopsy sepsis is a costly and life-threatening complication. With rising fluoroquinolone (FQ) resistance and novel augmented antibiotic regimens, we evaluated trends in antibiotic use and post-biopsy sepsis among patients undergoing prostate biopsy.
Methods: Using the MarketScan database, we identified privately insured men who underwent prostate biopsy (CPT 55700/55706) from 2009–2015. Our primary exposure was antibiotic regimen: oral vs augmented (oral+parenteral) vs parenteral. Primary outcome of interest was diagnosis of sepsis based on ICD-9 codes. We assessed frequency of emergency room (ER) visits or hospitalizations within 30 days following biopsy. We performed a subgroup analysis with receipt of FQ as the exposure of interest. We evaluated other factors (e.g., age, TRUS/transperineal approach, prior urinary tract infection, prior diabetes) and performed multivariable regression to estimate adjusted odds ratios for our outcomes of interest.
Results: We identified 128,306 men in our analytic cohort. Oral-only antibiotic regimens decreased from 80.5% in 2009 to 57.0% in 2015 (p<0.01). Use of augmented regimens increased from 7.5% to 25.9% (Figure). Use of FQs was nearly ubiquitous but decreased from 91.6% to 88.1% of regimens during study period (p<0.01). A diagnosis of sepsis was rare and did not change in frequency over time (0.34% 2009 vs 0.30% 2015). The frequency of post-biopsy ER visit or hospitalization was more common and relatively stable over time (3.1% 2009 vs 2.9% 2015). Use of augmented regimens was not associated with decreased sepsis risk (0.4 vs 0.3%, OR 1.18, 95% CI 0.91 – 1.53) or an ER visit/hospitalization (3.0 vs 3.0%, OR 1.08, 95% CI 0.98 – 1.19). Patients who did not receive FQs had an increased risk of sepsis (0.58% vs 0.33%, OR 1.70, 95% CI 1.29 – 2.24) and ER visit/hospitalization (4.0% vs 2.9%, OR 1.38, 95% CI 1.24 – 1.53).
Conclusions: Post-biopsy sepsis is rare among privately insured men who undergo prostate biopsy. The use of augmented antibiotic regimens is not associated with a significant decrease in post-biopsy sepsis. Despite rising concern about FQ-resistant bacteria, FQ use appears to be associated with decreased risk of sepsis. Source of