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

  • Urology - Original Paper
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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.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA

    Rosa Park, Justin Gyorfi, Joseph Y. Clark, Matthew G. Kaag, Kathleen Lehman & Jay D. Raman

  2. Department of Veterinary Sciences, The Pennsylvania State University, University Park, PA, USA

    Kalyan Dewan & Girish Kirimanjeswara

Authors
  1. Rosa Park
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  2. Justin Gyorfi
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  3. Kalyan Dewan
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  4. Girish Kirimanjeswara
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  5. Joseph Y. Clark
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  6. Matthew G. Kaag
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  7. Kathleen Lehman
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  8. Jay D. Raman
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Corresponding author

Correspondence to Jay D. Raman.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This was a retrospective review, and therefore formal consent was not required.

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Park, R., Gyorfi, J., Dewan, K. et al. Topical rectal antiseptic at time of prostate biopsy: how a resident patient safety project has evolved into institutional practice. Int Urol Nephrol 50, 1563–1568 (2018). https://doi.org/10.1007/s11255-018-1937-3

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  • DOI: https://doi.org/10.1007/s11255-018-1937-3

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