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Carbapenem sparing in the management of post-transrectal prostate biopsy bacteraemia.
ANZ J Surg 2019; 89(7-8):935-939AJ

Abstract

BACKGROUND

Sepsis following transrectal ultrasound (TRUS)-guided prostate biopsy is a major complication. With the emergence of multidrug-resistant organisms, empirical use of carbapenem antibiotics has been increasing. This study, conducted in the Illawarra Shoalhaven Local Health District (ISLHD), Australia, quantifies how much we can spare carbapenem use.

METHODS

A retrospective audit of patients who underwent TRUS prostate biopsy and were admitted post-operatively with proven bacteraemia between January 2007 and April 2016.

RESULTS

Of 2719 TRUS procedures, 50 (1.84%) cases had bacteraemia. The most common isolate was Escherichia coli in 44 of 50 (88%) of which six of 50 (12%) were extended-spectrum beta-lactamase (ESBL)-producing. Sixteen different empirical antimicrobial regimens were used, to which 42 of 50 (84%) of isolates were susceptible. Eight (16%) isolates were resistant to the chosen empiric combination, with five switched over to appropriate treatment once antimicrobial sensitivity results became available. Empirical carbapenem was utilized in 12 of 50 (24%) patients with only two of the ESBL isolates covered. A further 10 of 50 patients received carbapenems during their admission. Carbapenems could have been avoided in 18 of 22 (82%). A total of 86% of organisms (n = 43) were susceptible to the combination of amoxicillin-clavulanate and gentamicin.

CONCLUSION

Although the rates of bacteraemia with ESBL-producing organisms post-TRUS biopsy are increasing, use of carbapenem-free combination antimicrobials as empirical therapy appears to be safe and effective in our setting. Clinicians can utilize local resistance patterns to inform targeted and appropriate therapy for septic patients.

Authors+Show Affiliations

Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia. School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia.Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia. School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.Department of Urology, Wollongong Hospital, Wollongong, New South Wales, Australia.Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia. School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia. Department of Urology, Wollongong Hospital, Wollongong, New South Wales, Australia.School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia. NSW Health Pathology, Microbiology, Wollongong Hospital, Wollongong, New South Wales, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31272128

Citation

Trad, Mohamad-Ali, et al. "Carbapenem Sparing in the Management of Post-transrectal Prostate Biopsy Bacteraemia." ANZ Journal of Surgery, vol. 89, no. 7-8, 2019, pp. 935-939.
Trad MA, Materne M, Reynolds G, et al. Carbapenem sparing in the management of post-transrectal prostate biopsy bacteraemia. ANZ J Surg. 2019;89(7-8):935-939.
Trad, M. A., Materne, M., Reynolds, G., Yao, J., Miyakis, S., Skyring, T., & Newton, P. (2019). Carbapenem sparing in the management of post-transrectal prostate biopsy bacteraemia. ANZ Journal of Surgery, 89(7-8), pp. 935-939. doi:10.1111/ans.15322.
Trad MA, et al. Carbapenem Sparing in the Management of Post-transrectal Prostate Biopsy Bacteraemia. ANZ J Surg. 2019;89(7-8):935-939. PubMed PMID: 31272128.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carbapenem sparing in the management of post-transrectal prostate biopsy bacteraemia. AU - Trad,Mohamad-Ali, AU - Materne,Mishael, AU - Reynolds,Gemma, AU - Yao,Jinna, AU - Miyakis,Spiros, AU - Skyring,Tim, AU - Newton,Peter, Y1 - 2019/07/04/ PY - 2018/11/29/received PY - 2019/04/30/revised PY - 2019/05/11/accepted PY - 2019/7/5/pubmed PY - 2019/7/5/medline PY - 2019/7/5/entrez KW - TRUS biopsy KW - antimicrobial KW - bacteraemia KW - complications KW - sepsis KW - stewardship SP - 935 EP - 939 JF - ANZ journal of surgery JO - ANZ J Surg VL - 89 IS - 7-8 N2 - BACKGROUND: Sepsis following transrectal ultrasound (TRUS)-guided prostate biopsy is a major complication. With the emergence of multidrug-resistant organisms, empirical use of carbapenem antibiotics has been increasing. This study, conducted in the Illawarra Shoalhaven Local Health District (ISLHD), Australia, quantifies how much we can spare carbapenem use. METHODS: A retrospective audit of patients who underwent TRUS prostate biopsy and were admitted post-operatively with proven bacteraemia between January 2007 and April 2016. RESULTS: Of 2719 TRUS procedures, 50 (1.84%) cases had bacteraemia. The most common isolate was Escherichia coli in 44 of 50 (88%) of which six of 50 (12%) were extended-spectrum beta-lactamase (ESBL)-producing. Sixteen different empirical antimicrobial regimens were used, to which 42 of 50 (84%) of isolates were susceptible. Eight (16%) isolates were resistant to the chosen empiric combination, with five switched over to appropriate treatment once antimicrobial sensitivity results became available. Empirical carbapenem was utilized in 12 of 50 (24%) patients with only two of the ESBL isolates covered. A further 10 of 50 patients received carbapenems during their admission. Carbapenems could have been avoided in 18 of 22 (82%). A total of 86% of organisms (n = 43) were susceptible to the combination of amoxicillin-clavulanate and gentamicin. CONCLUSION: Although the rates of bacteraemia with ESBL-producing organisms post-TRUS biopsy are increasing, use of carbapenem-free combination antimicrobials as empirical therapy appears to be safe and effective in our setting. Clinicians can utilize local resistance patterns to inform targeted and appropriate therapy for septic patients. SN - 1445-2197 UR - https://www.unboundmedicine.com/medline/citation/31272128/Carbapenem_sparing_in_the_management_of_post-transrectal_prostate_biopsy_bacteraemia L2 - https://doi.org/10.1111/ans.15322 DB - PRIME DP - Unbound Medicine ER -