Urologists discuss their approaches to preventing post-prostate biopsy infection, including rectal swabs and antibiotic prophylaxis.
“I’ve started doing rectal cultures before the biopsy to make sure patients are not fluoroquinolone resistant because we were giving Cipro before biopsies, but the patients were resistant and they would get an infection.
Since I started doing the cultures, I have found a number of patients that were resistant, so we give them something like gentamicin before the procedure. That has eliminated the problem.”
Jennifer Linehan, MD
Dr. Takesita“I’m not doing anything differently. I understand it’s becoming more of the standard of care to actually do a rectal swab prior to the biopsy to see if patients have fluoroquinolone-resistant bacteria. If they do, you’re either supposed to give them a dose of gentamicin or a different antibiotic entirely.
We haven’t started that, primarily because it takes time to work it up-getting the rectal swab kit, making sure the staff knows how to submit it, and then sending it to the lab. Infections haven’t been a huge problem for my patients. We do a lot of biopsies and I haven’t seen very much of an increase in infections compared to the past, so I haven’t been pushed to change anything. If we started to see more people developing these infections, that would probably push me to start doing the swabs.”
Ken Takesita, MD
“Our protocol is that we typically give an oral fluoroquinolone, like Cipro, prior to and after the biopsy. We also give parenteral antibiotics, like intramuscular injections, a single dose, usually of Rocephin.
I don’t do rectal cultures. We switched to using two antibiotics about 4 or 5 years ago. We haven’t done a study on this, but the last time I had a patient have an infection was before we switched to two antibiotics and that’s been years.
The single-dose parenteral antibiotic is inexpensive. It’s a generic single dose given at the clinic that day. The cost of that compared to the cost of getting the culture, perhaps prescribing a different antibiotic, and then following up on it is much lower.
It’s also logistically easier because if you do a rectal swab on every patient, you have to follow up on the culture and call them with the results.
The infection rate in our community rose from 1% to 3% in 2000 to about 7% to 8% in 2010, using just a fluoroquinolone as the only antibiotic prophylaxis. Our response was to add a second antibiotic to cover potentially fluoroquinolone-resistant bacteria. That’s been a good solution for us.”
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