AUA antibiotic prophylaxis guidelines reduce infectious complications from prostate biopsy

Implementation of American Urology Association best practice guidelines reduced the number of different antibiotics used and the incidence of infectious complications among men undergoing biopsy for prostate cancer, according to results of a study presented at the Oncology Nursing Society Annual Congress.

American Urology Association (AUA) recently updated their guidelines on antibiotic prophylaxis prior to prostate biopsy to standardize regimens using a single antibiotic for up to 24 hours. The recommendations suggest consulting the local antibiogram and identify high-risk men, such as those who recently received antibiotics or had a previous biopsy-related infection.

Mary Schoen

“The prostate biopsy is the gold standard in obtaining a histological diagnosis,” Mary Schoen, MSN, MPH, AOCNP, of Memorial Sloan Kettering Cancer Center, told HemOnc Today. “Men diagnosed with low-risk prostate cancer are now being managed on active surveillance, meaning they will undergo multiple biopsies, leading to a concern about the development of infection-related complications. There also is evidence in the literature demonstrating antimicrobial resistance contributing to infectious complications after biopsy.”

Memorial Sloan Kettering Cancer Center implemented the AUA guidelines in 2013 to standardize prophylactic antibiotic use. Researchers developed an education program that included an antibiotic prophylaxis questionnaire and biopsy preparation checklist to assist nursing staff in applying the guidelines.

The goal of the current analysis was to assess the impact the guidelines had on infectious complications after biopsy. Schoen and colleagues compared data from men who received a biopsy in 2011 (n = 584) with men who received a biopsy in 2014 (n = 654).

The men were surveyed within 14 days following the procedure to provide information regarding complications.

Men in the 2011 group received a total of 19 different antibiotic agents. In this group, agents were typically started the evening before procedure and continued for up to 72 hours.

Ninety-six percent of men in the 2014 group received one of three standardized antibiotic regimens, which were typically started the day of the procedure and continued for 24 hours.

In the 2014 group, 98% of men received a one-drug regimen compared with 73% of men in the 2011 group.

Fluoroquinolone prophylaxis was the most common regimen in both groups.

“We were surprised by the number of different antibiotic regimens prescribed by urologists within our own practice,” Schoen said. “After implementation of the AUA guidelines, we were able to decrease the number of different regimens prescribed from 19 down to three. Adherence to the AUA guidelines had a clinically significant impact on our infection rates and helped reduce the number of patients being hospitalized for sepsis.”

After implementing the AUA guidelines, infection rates decreased from 3.3% in the 2011 group to 2.8% in the 2014 group (difference, –0.55, 95% one-sided CI, 1.1).

“This research has a very positive effect on our practice insofar as the nurses and physicians are adhering to the new standards because it works and has improved the quality of patient care,” Schoen said. “Nurses are responsible for educating the patients on prebiopsy instructions and helping to evaluate the most appropriate antibiotic prophylaxis. Because our instructions are now standardized, there is no room for confusion. We are all following the same guidelines and questionnaires.” —by Nick Andrews

Schoen M, et al. Abstract. Presented at: ONS Annual Congress; April 28-May 1, 2016; San Antonio, Texas.

Disclo sure: HemOnc Today was unable to confirm the researchers’ relevant financial disclosures.