Enhancing the Safety of Prostate Biopsy

An early initiative in MUSIC focused on reducing the frequency of adverse events after transrectal ultrasound guided prostate biopsy as a diagnostic tool for prostate cancer. A key concern identified by MUSIC urologists was the rising frequency of post-prostate biopsy hospitalizations due to severe infections.  In reviewing the MUSIC data, we identified that 1.3% of men in the state were admitted to the hospital following prostate biopsy, 92% of the hospitalizations were due to infection, and 80% of those were due to fluoroquinolone resistance.  Thus, the collaborative recognized that the key to reducing the majority of prostate biopsy-related hospitalizations was to address fluoroquinolone resistance.

As a result of its early findings, MUSIC developed two pathways for addressing fluoroquinolone resistance.  The first pathway involves the use of rectal swab cultures prior to prostate biopsy to identify the presence of any fluoroquinolone-resistant organisms, and to allow the subsequent tailoring of antibiotic prophylaxis with culture-directed agents. The second pathway does not use rectal swabs, but rather assumes that fluoroquinolone-resistant organisms are present and adds a second antimicrobial to standard fluoroquinolone prophylaxis.  The detailed protocol for these two pathways can be accessed via the following link: MUSIC Biopsy Pathway Protocol.  Our early work around this priority has been quite successful, with the data demonstrating a nearly fifty percent relative reduction in prostate biopsy‐related hospitalizations since the initiation of MUSIC’s quality improvement activities in this area.

MUSIC also created a prostate biopsy checklist that helps to capture patient risk factors that may increase the risk for a complication post-biopsy, as well as the indication for the prostate biopsy. A copy of the checklist that was implemented in conjunction with one or both pathways at all of the participating MUSIC practices can be found via the following link: MUSIC Prostate Biopsy Checklist.

A video highlighting MUSIC’s biopsy QI efforts can be viewed below.

Since MUSIC’s development of the antibiotic pathways to address fluoroquinolone resistance, the collaborative has sought to identify ways to further reduce the risk of prostate biopsy-related infectious complications.  Accordingly, MUSIC developed a prostate biopsy infection “bundle” that incorporates not only updated MUSIC antibiotic pathways and the MUSIC biopsy check list, but also recommends a urinalysis prior to biopsy, as well as the use of a needle disinfectant technique to further lower the risk of prostate-biopsy related hospitalization due to infection.  MUSIC prepared a biopsy toolkit including information concerning the “bundle,” as well as recommendations for repeat biopsy for patients with premalignant pathology, and a copy  can be found here.  You can also click on the following link for a video demonstrating the recommended needle disinfectant techniques: https://www.youtube.com/watch?v=I8pXqjhUeiw.