528. The Epidemiology of Infectious Complications (IC) after Transrectal Ultrasound-Guided Prostate Biopsy (TRUSB) in a Community Hospital Setting: To Screen or Not to Screen?
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_2013_poster.pdf (567.2 kB)
  • Background:

    We evaluated the incidence of post-TRUSB infectious complications (IC) at NSUHS following a previous modification of prophylaxis to determine whether patients would further benefit from adopting targeted antimicrobial prophylaxis (AP) using rectal swab cultures prior to TRUSB.

    Methods:

    We performed a cohort study of men who underwent TRUSB between 1/1/07 and 12/31/12 at NSUHS (4 hospitals, 832 beds).  Chart review was performed on patients who either visited the ED or who were admitted within 7 days following TRUSB to evaluate for IC.  Demographic and clinical data were collected.  Cases were defined as patients with positive cultures and/or a clinical picture consistent with infection.  Recommended AP included levofloxacin (LEV) 750mg po daily for 3 days (1st dose prior) and cefpodoxime (CEF) 400 mg po q12 hours (1st dose prior) for 1 day.  LEV was included for SCIP compliance.  We also reviewed all outpatient urine cultures obtained from men between 1/1/07 and 12/31/12 in which E. coli was isolated to evaluate for changes in resistance by comparing isolates from years 2010-2012 (period 1) to isolates from 2007-2009 (period 2).  Duplicate isolates from the same patient were excluded.    

    Results:

    Of the 3212 men who underwent TRUSB, 26 (0.81%) returned to the ED or were hospitalized within 7 days for an IC.  The average LOS was 3 days.  21/26 (80.1%) of patients had documented AP including 10 (LEV/CPD), 8 LEV, 1 CEF, 2 other.  17/26 (65.4%) developed bacteremia and/or bacteruria, 4 (15.4%) had negative cultures, and 5 (19.2%) had no cultures.  E. coli was isolated from 16 (94.1%) of cultures, of which 1 was pan-susceptible, 7 were FQ-resistant, and 8 were ESBL-producing.  The incidence of FQ-resistance did not significantly increase over the study period (21.8% vs. 24.1% RR 1.11, p=0.09).  The incidence of CEF-resistant and ESBL-E. coli urine isolates significantly increased from period 1 to period 2 (8.3% vs. 10.2%, RR=1.23, p=0.053 and 8% vs. 5.3%; RR1.42, p=0.02, respectively).

    Conclusion:

    Despite the increase in resistant E. coli isolated from urine, NSUHS has not experienced a significant increase in post-TRUSB infections to date.  The use of rectal screening cultures for targeted AP should be determined on an institutional basis as determined by local epidemiology and ongoing post-biopsy surveillance.

    Becky Smith, MD1, Marc-Oliver Wright, MT(ASCP), MS, CIC 2, Richard Thomson Jr., PhD3, Donna Schora2, Lance R. Peterson, MD2 and Ari Robicsek, MD4, (1)Infectious Diseases, Pritzker School of Medicine, University of Chicago, Chicago, IL, (2)NorthShore University HealthSystem, Evanston, IL, (3)Pathology, Evanston Northwestern Healthcare, Evanston, IL, (4)Northshore University Healthsystem, Evanston, IL

    Disclosures:

    B. Smith, None

    M. O. Wright, None

    R. Thomson Jr., None

    D. Schora, None

    L. R. Peterson, None

    A. Robicsek, None

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