530. Prophylactic 3rd Generation Cephalosporins Reduce Infection Rates after Transrectal Prostatic Biopsy
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Infectious complications after transrectal ultrasono-guided prostatic biopsy (TRUS-PB) are major post-biopsy morbidities. We have prescribed fluoroquinolones for prophylaxis. However since the resistance rate of community acquired  E.coli to fluoroquinolones exceeds 20%, infections due to fluoroquinolone-resistant organisms are increasingly observed. We tried to reduce TRUS-PB related infections with prophylactic 3rdgeneration cephalosporins rather than fluoroquinolones.

Methods: Before September 2012, the prophylactic antibiotic regimen for TRUS-PB was Ciprofloxacin 500mg bid PO for 5 days starting on the day before biopsy. It was changed to 1 dose of Ceftriaxone 1g IV 1 hour before biopsy plus Cefixime 100mg bid PO for 5 days starting on the day before. We retrospectively reviewed electronic medical records of patients who underwent TRUS-PB 14 months before and 7 months after change of protocols for infectious complications. Infection rates and causative organisms with their antimicrobial susceptibility were compared.

Results: TRUS-PB related infection rates were 3.19% (26/816) before and 1.03% (4/389) after implementing the new protocol (P = 0.012). The predominant organism was E. coli: 92.3% (24/26) before and 100% (4/4) after protocol change. Ciprofloxacin resistance was 100% (24/24) and 75% (3/4), respectively. ESBLs were identified in 37.5% (9/24) before and 75% (3/4) after protocol change.

Conclusion: A prophylactic regimen containing 3rd generation cephalosporins would be better than a fluoroquinolone in a community where fluoroquinolone resistance of E. coli exceeds 20%.

Nak-Hyun Kim, MD1, Moonsuk Kim, MD2, Shinhye Cheon, MD2, Younghee Jung, MD2, Myung Jin Lee, MD2, Kyoung-Ho Song1, Pyoeng Gyun Choe, MD1, Ji Hwan Bang, MD, PhD2, Wan Beom Park, MD, PhD2, Eu Suk Kim1, Sang Won Park, MD, PhD1, Hong Bin Kim1, Myoung-Don Oh, MD, PhD2, Cheol Kwak, MD, PhD3, Nam Joong Kim, MD, PhD2 and Chung-Jong Kim, MD1, (1)Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, (2)Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, (3)Urology, Seoul National University College of Medicine, Seoul, South Korea

Disclosures:

N. H. Kim, None

M. Kim, None

S. Cheon, None

Y. Jung, None

M. J. Lee, None

K. H. Song, None

P. G. Choe, None

J. H. Bang, None

W. B. Park, None

E. S. Kim, None

S. W. Park, None

H. B. Kim, None

M. D. Oh, None

C. Kwak, None

N. J. Kim, None

C. J. Kim, None

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