Womble Paul R, Dixon Maxwell W, Linsell Susan M, Ye Zaojun, Montie James E, Lane Brian R, Miller David C, Burks Frank N
Department of Urology, University of Michigan, Ann Arbor, Michigan.
University of Michigan Medical School, Ann Arbor, Michigan.
J Urol. 2014 Jun;191(6):1787-92. doi: 10.1016/j.juro.2013.12.026. Epub 2013 Dec 15.
While transrectal prostate biopsy is the cornerstone of prostate cancer diagnosis, serious post-biopsy infectious complications are reported to be increasing. A better understanding of the true prevalence and microbiology of these events is needed to guide quality improvement in this area and ultimately better early detection practices.
Using data from the MUSIC registry we identified all men who underwent transrectal prostate biopsy at 21 practices in Michigan from March 2012 to June 2013. Trained data abstractors recorded pertinent data including prophylactic antibiotics and all biopsy related hospitalizations. Claims data and followup telephone calls were used for validation. All men admitted to the hospital for an infectious complication were identified and their culture data were obtained. We then compared the frequency of infection related hospitalization rates across practices and according to antibiotic prophylaxis in concordance with AUA best practice recommendations.
The overall 30-day hospital admission rate after prostate biopsy was 0.97%, ranging from 0% to 4.2% across 21 MUSIC practices. Of these hospital admissions 95% were for infectious complications and the majority of cultures identified fluoroquinolone resistant organisms. AUA concordant antibiotics were administered in 96.3% of biopsies. Patients on noncompliant antibiotic regimens were significantly more likely to be hospitalized for infectious complications (3.8% vs 0.89%, p=0.0026).
Infection related hospitalizations occur in approximately 1% of men undergoing prostate biopsy in Michigan. Our findings suggest that many of these events could be avoided by implementing new protocols (eg culture specific or augmented antibiotic prophylaxis) that adhere to AUA best practice recommendations and address fluoroquinolone resistance.
虽然经直肠前列腺活检是前列腺癌诊断的基石，但据报道活检后严重的感染并发症正在增加。需要更好地了解这些事件的真实患病率和微生物学情况，以指导该领域的质量改进，并最终改善早期检测方法。
利用MUSIC注册中心的数据，我们确定了2012年3月至2013年6月在密歇根州21家医疗机构接受经直肠前列腺活检的所有男性。训练有素的数据提取人员记录了相关数据，包括预防性抗生素和所有与活检相关的住院情况。索赔数据和随访电话用于验证。确定所有因感染并发症入院的男性，并获取他们的培养数据。然后，我们根据AUA最佳实践建议，比较了各医疗机构之间以及根据抗生素预防情况的感染相关住院率。
前列腺活检后30天的总体住院率为0.97%，在21家MUSIC医疗机构中，住院率范围为0%至4.2%。在这些住院病例中，95%是由于感染并发症，并且大多数培养物鉴定出对氟喹诺酮耐药的微生物。96.3%的活检使用了符合AUA标准的抗生素。接受不符合标准抗生素方案的患者因感染并发症住院的可能性显著更高（3.8%对0.89%，p=0.0026）。
在密歇根州，接受前列腺活检的男性中约有1%会发生与感染相关的住院情况。我们的研究结果表明，通过实施符合AUA最佳实践建议并解决氟喹诺酮耐药问题的新方案（如特定培养或强化抗生素预防），许多此类事件是可以避免的。
