Concepcion Raoul S, Schaeffer Edward M, Shore Neal D, Kapoor Deepak A, Scott Jeffrey A, Kirsh Gary M
Integra Connect West Palm Beach, FL.
Vanderbilt University School of Medicine Nashville, TN.
Rev Urol. 2019;21(2-3):93-101.
Given the number of prostate biopsies performed annually in the United States and associated infectious events as a result, we sought to determine if implementation of a standardized biopsy protocol utilizing antibiotic prophylaxis based on locally derived antibiograms would result in a decrease, relative to a contemporary control population, in the incidence of infection-related complications among community-based practices. A total of nine member groups of LUGPA participated in both a retrospective review and a prospective study of infection-related complications following prostate biopsy. Historic infectious complications, defined as chills/rigor, temperature higher than 101 °F, or documented positive blood or urine cultures, were self-reported by a retrospective review of patients undergoing prostate biopsy under the practice's current protocol in the year prior to the study. The prospective phase of the study required each group to develop a locally derived augmented prophylaxis regimen (>2 antibiotics) based on local antibiograms. After implementation, the practices enrolled patients undergoing prostate biopsy over an 8-week period. Monitoring for infection-related complication took place over the ensuing 3 weeks post-biopsy. Seven hundred fifty-nine patients over nine practices were enrolled into the study utilizing the augmented locally determined prophylaxis protocol. There was a 53% reduction in the incidence of infection-related complication, relative to the historical rate. By developing a standardized biopsy protocol with specific emphasis on incorporating an augmented antibiotic prophylactic regimen based upon local antibiograms, we were able to demonstrate in a prospective trial across nine geographically distinct community practices a significant reduction in the incidence of infection-related complications.
鉴于美国每年进行的前列腺活检数量以及由此引发的相关感染事件，我们试图确定，相对于当代对照人群，实施基于本地药敏谱的抗生素预防标准化活检方案是否会降低社区医疗实践中感染相关并发症的发生率。LUGPA的九个成员小组参与了前列腺活检后感染相关并发症的回顾性审查和前瞻性研究。历史性感染并发症定义为寒战/恶寒、体温高于101°F或记录在案的血培养或尿培养阳性，通过对研究前一年按照该医疗机构现行方案接受前列腺活检的患者进行回顾性审查来自我报告。研究的前瞻性阶段要求每个小组根据本地药敏谱制定一种本地衍生的强化预防方案（>2种抗生素）。实施后，这些医疗机构在8周内纳入了接受前列腺活检的患者。在活检后的接下来3周内对感染相关并发症进行监测。利用强化的本地确定预防方案，九个医疗机构的759名患者被纳入研究。相对于历史发生率，感染相关并发症的发生率降低了53%。通过制定一个标准化活检方案，特别强调纳入基于本地药敏谱的强化抗生素预防方案，我们在一项涉及九个地理位置不同的社区医疗实践的前瞻性试验中证明，感染相关并发症的发生率显著降低。
