Evaluation of a needle disinfectant technique to reduce infection-related hospitalisation after transrectal prostate biopsy

BJU Int. 2018 Feb;121(2):232-238. doi: 10.1111/bju.13982. Epub 2017 Sep 3.

Abstract

Objectives: To determine whether a needle disinfectant step during transrectal ultrasonography (TRUS)-guided prostate biopsy is associated with lower rates of infection-related hospitalisation.

Patients and methods: We conducted a retrospective analysis of all TRUS-guided prostate biopsies taken across the Michigan Urological Surgery Improvement Collaborative (MUSIC) from January 2012 to March 2015. Natural variation in technique allowed us to evaluate for differences in infection-related hospitalisations based on whether or not a needle disinfectant technique was used. The disinfectant technique was an intra-procedural step to cleanse the biopsy needle with antibacterial solution after each core was sampled (i.e., 10% formalin or 70% isopropyl alcohol). After grouping biopsies according to whether or not the procedure included a needle disinfectant step, we compared the rate of infection-related hospitalisations within 30 days of biopsy. Generalised estimating equation models were fit to adjust for potential confounders.

Results: During the evaluated period, 17 954 TRUS-guided prostate biopsies were taken with 5 321 (29.6%) including a disinfectant step. The observed rate of infection-related hospitalisation was lower when a disinfectant technique was used during biopsy (0.60% vs 0.90%; P = 0.04). After accounting for differences between groups the adjusted hospitalisation rate in the disinfectant group was 0.85% vs 1.12% in the no disinfectant group (adjusted odds ratio 0.76, 95% confidence interval 0.50-1.15; P = 0.19).

Conclusions: In this observational analysis, hospitalisations for infectious complications were less common when the TRUS-guided prostate biopsy included a needle disinfection step. However, after adjusting for potential confounders the effect of needle disinfection was not statistically significant. Prospective evaluation is warranted to determine if this step provides a scalable and effective method to minimise infectious complications.

Keywords: infection; prostate biopsy; prostate cancer; quality improvement.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biopsy, Large-Core Needle / adverse effects
  • Cross Infection / etiology
  • Disinfection / methods*
  • Fever / etiology
  • Hospitalization / statistics & numerical data*
  • Humans
  • Image-Guided Biopsy / adverse effects
  • Male
  • Middle Aged
  • Needles / microbiology*
  • Prostate / pathology*
  • Prostatic Neoplasms / pathology*
  • Retrospective Studies
  • Sepsis / etiology
  • Urinary Tract Infections / etiology