Correction: Predictors of fluoroquinolone-resistant bacteria in the rectal vault of men undergoing prostate biopsy.

The original version of this article contained an error in the name of author Alfredo Mena Lora. This has now been corrected.

Predictors of fluoroquinolone-resistant bacteria in the rectal vault of men undergoing prostate biopsy.

IMPORTANCE: Fluoroquinolone (FQ)-resistant rectal vault flora is associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-PNB). OBJECTIVE: To determine the patient factors that predict FQ-resistant rectal cultures in men who are undergoing transrectal ultrasound-guided prostate needle biopsy. METHODS: An IRB approved retrospective review of 6183 consecutive men who had undergone a rectal swab culture in preparation for TRUS-PNB between January 2013 and December 2014 was performed. Multivariable logistic regression was used to determine the clinical and demographic factors associated with FQ-resistant Enterobacteriaceae in the rectal vault. RESULTS: Of the 6179 rectal swabs analyzed, 4842 (78%) were FQ-sensitive, and 1337 (22%) were FQ-resistant. On univariable analysis, increasing age, prior TRUS-PNB, higher number of biopsy cores obtained, diabetes mellitus, antimicrobial use within the past 6 months and non-Caucasian race were predictors of FQ-resistance (all p < 0.05). Men with FQ-resistant cultures were more likely to have benign pathology on TRUS-PNB (p = 0.004). On multivariable analysis, increasing patient age (OR = 1.01/year [1.00-1.02]), use of antimicrobials in the last 6 months (OR = 2.85[2.18-3.72]), African American (OR = 1.99 [1.66-2.37]), Asian (OR = 3.39 [2.63-4.37]), and Hispanic (OR = 2.10 [1.72-2.55]) races were independently associated with FQ-resistant rectal cultures. The overall infectious rate was 1.1% (56/5214) and the sepsis rate was 0.46% (24/5214). The infection rate in the FQ-resistant group was 3.9% (43/1107) compared to FQ-sensitive group 0.3% (13/4107), p < 0.001. CONCLUSION: In this cohort, increasing age, recent antimicrobial-use, and non-Caucasian race were independent predictors of FQ-resistance in the rectal vault. As FQ-resistance is associated with infectious complications from transrectal ultrasound-guided prostate needle biopsy, understanding risk factors may assist infection control efforts.

Predictors of Infectious Complications after Targeted Prophylaxis for Prostate Needle Biopsy.

PURPOSE: The incidence of infectious complications after transrectal ultrasound guided prostate needle biopsy is rising. We sought to identify the incidence and predictors of infection in a large cohort of men undergoing biopsy who receive targeted prophylaxis. MATERIALS AND METHODS: We retrospectively reviewed the records of 5,214 consecutive patients who underwent transrectal ultrasound guided prostate needle biopsy from January 2013 to December 2014 at UroPartners, a large urology group comprising 28 clinics in metropolitan Chicago. At 1 microbiology laboratory all swabs were processed, the presence of fluoroquinolone resistant gram-negative rods was identified and sensitivity tests were performed. Prophylaxis for biopsy was guided by rectal swab culture. Characteristics of patients with and without infectious complications were compared using the Kruskal-Wallis and chi-square tests. Multivariable logistic regression was done to determine predictors of infectious complications. Analyses were performed with R, version 2.14.2 (https://www.r-project.org/). RESULTS: Of the 5,214 biopsies performed 56 infectious (1.1%) and 24 sepsis complications (0.46%) were found. On univariable analysis nonCaucasian race and fluoroquinolone resistant microbes were predictors of infection (p <0.05). On multivariable analysis fluoroquinolone resistant rectal vault flora (OR 9.98, 95% CI 3.79-26.3) and the number of biopsy cores taken (OR 1.28 per core, 95% CI 1.04-1.54) were independent predictors of infection. CONCLUSIONS: Despite targeted prophylaxis patients with fluoroquinolone resistant rectal vault flora have higher odds of infectious complications following transrectal ultrasound guided prostate needle biopsy. In these patients one should consider using other biopsy approaches or techniques to minimize risk.

The effectiveness of inking needle core prostate biopsies for preventing patient specimen identification errors: a technique to address Joint Commission patient safety goals in specialty laboratories.

CONTEXT: The elimination or reduction of medical errors has been a main focus of health care enterprises in the United States since the year 2000. Elimination of errors in patient and specimen identification is a key component of this focus and is the number one goal in the Joint Commission's 2008 National Patient Safety Goals Laboratory Services Program. OBJECTIVE: To evaluate the effectiveness of using permanent inks to maintain specimen identity in sequentially submitted prostate needle biopsies. DESIGN: For a 12-month period, a grossing technician stained each prostate core with permanent ink developed for inking of pathology specimens. A different color was used for each patient, with all the prostate cores from all vials for a particular patient inked with the same color. Five colors were used sequentially: green, blue, yellow, orange, and black. The ink was diluted with distilled water to a consistency that allowed application of a thin, uniform coating of ink along the edges of the prostate core. The time required to ink patient specimens comprising different numbers of vials and prostate biopsies was timed. The number and type of inked specimen discrepancies were evaluated. RESULTS: The identified discrepancy rate for prostate biopsy patients was 0.13%. The discrepancy rate in terms of total number of prostate blocks was 0.014%. Diluted inks adhered to biopsy contours throughout tissue processing. The tissue showed no untoward reactions to the inks. Inking did not affect staining (histochemical or immunohistochemical) or pathologic evaluation. On average, inking prostate needle biopsies increases grossing time by 20%. CONCLUSIONS: Inking of all prostate core biopsies with colored inks, in sequential order, is an aid in maintaining specimen identity. It is a simple and effective method of addressing Joint Commission patient safety goals by maintaining specimen identity during processing of similar types of gross specimens. This technique may be applicable in other specialty laboratories and high-volume laboratories, where many similar tissue specimens are processed.