Gupta, Kalpana

Lerner, Lori

Marino, Kaylee

Orlando, Ralph

Parlee, Anne

Strymish, Judith

Harvard University - DASH 

491Comparative Effectiveness ofSingle vs Combination AntibioticProphylaxis for TRUS-biopsyThe Harvard community has made thisarticle openly available.  Please share  howthis access benefits you. Your story mattersCitation Marino, Kaylee, Judith Strymish, Anne Parlee, Lori Lerner, RalphOrlando, and Kalpana Gupta. 2014. “491Comparative Effectivenessof Single vs Combination Antibiotic Prophylaxis for TRUS-biopsy.”Open Forum Infectious Diseases 1 (Suppl 1): S181. doi:10.1093/ofid/ofu052.357. http://dx.doi.org/10.1093/ofid/ofu052.357.Published Version doi:10.1093/ofid/ofu052.357Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:35981954Terms of Use This article was downloaded from Harvard University’s DASHrepository, and is made available under the terms and conditionsapplicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA491. Comparative Effectiveness of Single vs Combination AntibioticProphylaxis for TRUS-biopsyKaylee Marino, PharmD1; Judith Strymish, MD2,3; Anne Parlee, PharmD1; Lori Lerner,MD4; Ralph Orlando, MD4; Kalpana Gupta, MD, MPH5; 1Pharmacy, VA BostonHealthcare System, Boston, MA; 2Infectious Disease, VA Boston Healthcare System,West Roxbury, MA; 3Harvard Medical School, Boston, MA; 4Urology, VA BostonHealthcare System, Boston, MA; 5VA Boston Health Care System, West Roxbury, MASession: 48. Treatment of Antimicrobial Resistant InfectionsThursday, October 9, 2014: 12:30 PMBackground. Single agent prophylaxis with ﬂuoroquinolones (FQ) or cephalospo-rins (drugs of choice) or trimethoprim-sulfamethoxazole or aminoglycosides(alternatives) is recommended prior to transrectal ultrasound guided prostate biopsy(TRUS-biopsy). However increasing FQ resistance (FQ-R) has led to a rise in post-biopsy infections. We sought to compare the rate of infectious related complicationsin patients receiving ciproﬂoxacin vs alternative regimens such as ciproﬂoxacin plus acephalosporin or a non-FQ regimen for TRUS-biopsy prophylaxis.Methods. A total of 487 men who underwent a TRUS-biopsy at VA BostonHealthcare System between 2011-2013 were retrospectively evaluated for infectionswithin 30 days, including symptomatic urinary tract infection (UTI) with fever, bacter-emia, or sepsis. Men undergoing concurrent procedures or lacking documentation ofprophylaxis compliance were excluded. Electronic records were used to extract out-come data from the national VA healthcare system, including outpatient and urgentcare visits.Results. Of 455 men evaluated, there were 25 infections (5.5%), with sepsis occur-ring in 2.4%, UTI in 1.5% and bacteremia in 0.4% of patients. E. coli was the most com-mon urine (89%) and blood pathogen (92%), with FQ-R rates of 88% and 91%respectively. Ciproﬂoxacin alone was associated with signiﬁcantly more infectionsthan ciproﬂoxacin plus an additional agent (p = 0.019). Intramuscular gentamicinalone was also signiﬁcantly associated with a higher infection rate compared to allother regimens (p = 0.014). Ciproﬂoxacin plus cefpodoxime was the most commoncombination regimen. Any combination was highly protective, with a 75% reductionin infection rate compared to ciproﬂoxacin or gentamicin alone (OR 0.25, 95% CI 0.06;0.77, p = 0.01). Diabetes, immunosuppression, hospitalization within prior year, andUTI within the previous 6 months were not associated with post-biopsy infection risk.Conclusion. The overall incidence of post TRUS-biopsy infection in this cohortwas higher than previous reports. The ﬁndings suggest that ciproﬂoxacin or gentami-cin alone are inferior regimens compared to a combination regimen. The preferredcombination likely depends on local susceptibility data.Disclosures. K. Gupta, Paratek: Consultant, Consulting feeS166 • OFID 2014:1 (Suppl 1) • Poster Abstracts

491Comparative Effectiveness of Single vs Combination Antibiotic Prophylaxis for TRUS-biopsy

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491Comparative Effectiveness of Single vs Combination Antibiotic Prophylaxis for TRUS-biopsy

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