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

Introduction: A number of strategies have been attempted to minimize the risk of infection following transrectal prostate procedures. We report our prospective efforts at augmenting our prophylaxis strategy over time. Methods: Since 2010 we have prospectively monitored infections after transrectal prostate procedures 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 aminoglycoside to our prophylaxis regimen of fluoroquinolones 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 during this period. Results: From 2010 to 2016 we performed 2,398 transrectal prostate procedures. Overall there were 41 cases (1.7%) of infection related hospitalization. However, the rate differed significantly during the course of the study period. The infection related hospitalization rate declined from 3.8% to 1.1% in the first 3 years following the addition of intramuscular aminoglycoside (2011 to 2013), a decrease of 69%. In 2014 our infection rate increased to 2.6%, prompting the initiation of protocol 3, wherein the addition of target prophylaxis and formalin needle tip disinfection identified a 29.8% fluoroquinolone resistance rate and resulted in another decline in our infection rate to 1.2% (a decrease of 53%). Conclusions: While the initial addition of intramuscular 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.