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

Rosa Park, Justin Gyorfi, Kalyan Dewan, Girish Kirimanjeswara, Joseph Y. Clark, Matthew G. Kaag, Kathleen Lehman, Jay D. Raman

Research output: Contribution to journalArticle

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1563-1568
Number of pages6
JournalInternational Urology and Nephrology
Volume50
Issue number9
DOIs
StatePublished - Sep 1 2018

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Urology

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