MP40-01 EVALUATION OF PRE-BIOPSY RECTAL SWABS, AUGMENTED ANTIBIOTICS, AND FORMALIN NEEDLE DISINFECTION ON RATES OF TRANSRECTAL PROSTATE BIOPSY COMPLICATIONS

INTRODUCTION AND OBJECTIVES:The last two decades have witnessed an increase in sepsis following transrectal prostate biopsy (TRPB), predominantly due to a rise in fluoroquinolone resistance.As a result, numerous strategies have been proposed to decrease sepsis related complications.We assessed our institutional trends for biopsy related complications following the implementation of augmented antibiotics, rectal swab culturedirected antibiotics, and use of formalin needle disinfectant technique.METHODS: Patients undergoing TRPB were identified by reviewing a prospectively maintained clinical registry.The use of augmented antibiotics and rectal swab culture-directed antibiotics was introduced in 2013.Formalin needle disinfectant technique following each biopsy core was introduced in 2016.To evaluate the impact of these techniques on morbidity, post-biopsy complication rates following implementation of augmented and culture-directed prophylaxis (2013-2015) and after addition of formalin needle disinfectant technique (2016) were compared to complication rates prior to modification of our biopsy protocol (2012).RESULTS: A total of 2,549 patients underwent TRPB during a 5 year period.In 2012, prior to protocol modification, infectious complications occurred in 1.9% of patients, consisting of sepsis in 0.63%, UTI in 0.63%, and post-biopsy fever in 0.63%.Following the introduction of rectal swabs and augmented antibiotics in 2013, 63.23% of patients received culture-directed antibiotics and 13.7% received augmented IV/IM prophylaxis.Between 2013 and 2015, sepsis, UTI, and post-biopsy fever rates were 0.28% (p¼0.29),0.98% (p¼0.75), and 1.54% (p¼0.29),respectively.In 2016, following implementation of both rectal swabs and formalin needle disinfectant technique, rates of sepsis, UTI, and post-biopsy fever were 0.00% (p¼0.08),0.37% (p¼0.62), and 1.24% (p¼0.53),respectively.A time trend analysis of complication rates is provided in Figure 1.CONCLUSIONS: Following incorporation of both culturedirected antibiotics and formalin needle disinfectant technique, a trend towards decreased sepsis rates (0.00%, p¼0.08) was achieved at our institution.This regimen thus has the potential to dramatically reduce or eliminate post-biopsy sepsis.