Prospective Monitoring and Adapting Strategies for Prevention of Infection Following Transrectal Prostate Procedures

Introduction: A number of strategies have been attempted to minimize infection risk following transrectal prostate procedures (TRPXs). We report our prospective efforts at augmenting our prophylaxis strategy over time.

Methods: Since 2010, we prospectively monitor post-TRPX infections and changed our prophylaxis regimen twice in an effort to respond to increases in infectious complications. In 2011 we added a single-dose of intramuscular (IM) aminoglycoside to our prophylaxis regimen of fluoroquinolones (FQ) or trimethoprim-sulfamethoxazole. In 2015 we began performing formalin needle-tip disinfection before each biopsy and screening high-risk patients for antibiotic resistance using rectal swab cultures (targeted prophylaxis). We report our rates of infections and antibiotic resistance patterns over this period.

Results: From 2010-2016, we performed 2398 TRPXs; overall, there were 41 cases (1.7%) of infection-related hospitalization, however the rate differed significantly over the study period. The infection-related hospitalization rate declined from 3.8 to 1.1% in the first 3 years following the addition of IM aminoglycoside (2011-2013) - a decrease of 69%. In 2014 our infection rate increased to 2.6% prompting initiation of protocol #3 wherein the addition of target prophylaxis and formalin needle-tip disinfection identified a 29.8% FQ-resistance rate and resulted in another decline in our infection rate to 1.2% - a decrease of 53%.

Conclusions: While the initial addition of IM aminoglycoside appeared to be effective in decreasing post-procedure infections, further augmentation of our prophylaxis regimen through rectal swab screening of high-risk patients and formalin needle-tip disinfection led to an additional decline in rates of infection-related hospitalizations.