Topical rectal antiseptic at time of prostate biopsy: how a resident patient safety project has evolved into institutional practice.

Abstract

PURPOSE:

To report outcomes 5 years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol.

METHODS:

A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4% chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring.

RESULTS:

Median age and PSA of men included in this study were 64 years and 12 ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on immunosuppression, 32% had at least one prior biopsy, 14% received antibiotics, and 7% were hospitalized in the past 6 months. 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3%, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring.

CONCLUSIONS:

What started as a resident quality safety project 5 years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.

• Authors: Rosa Park, Justin Gyorfi, Kalyan Dewan, Girish Kirimanjeswara, Joseph Y Clark, Matthew G Kaag, Kathleen Lehman, Jay D Raman
• Journal: International urology and nephrology (Int Urol Nephrol) Vol. 50 Issue 9 Pg. 1563-1568 (Sep 2018) ISSN: 1573-2584 [Electronic] Netherlands
• PMID: 30019310 (Publication Type: Journal Article)

Chemical References

• Anti-Infective Agents, Local
• Povidone-Iodine
• Chlorhexidine

Topics

• Administration, Topical
• Aged
• Anti-Infective Agents, Local (administration & dosage)
• Antisepsis (methods)
• Chlorhexidine (administration & dosage)
• Critical Care
• Hospitalization
• Humans
• Image-Guided Biopsy (adverse effects, methods)
• Male
• Middle Aged
• Patient Safety
• Povidone-Iodine (administration & dosage)
• Prostate (pathology)
• Quality Improvement
• Sepsis (etiology, prevention & control)
• Urinary Tract Infections (etiology, prevention & control)