PD31-08 FLUOROQUINOLONE RESISTANCE IN THE RECTAL CARRIAGE OF MEN IN AN ACTIVE SURVEILLANCE COHORT
1
RESULTS: There were 333 (17.7%) men who had AO exposure. AO exposed men were younger (median 59 vs. 62 years), had lower preoperative PSA (5.8 vs. 6.7 ng/mL) and clinical stage (25 vs. 39% palpable), and higher BMI (28.2 vs. 27.6 kg/m2), all p<0.01. Biopsy GS did not differ. Pathologic GS, rate of positive margins and positive lymph nodes, and extracapsular extension did not differ, however men with AO exposure had a lower rate of seminal vesicle invasion (7.0 vs. 10.9%,p¼0.04). At a median follow-up of 85 months, 702 (37.4%) of patients had BCR, 78 (4.1%) had metastases, and 39 (2.1%) died from PC. On multi- variable analysis, AO exposure was not associated with BCR, metastases, or PC mortality. CONCLUSIONS: In this cohort of PC patients treated with RP, AO exposure was not associated with worse preoperative characteristics such as elevated PSA or biopsy GS, nor was it associated with worse postoperative long-term outcomes of me- tastases or PC death. Thus, as the data on AO exposed men matures, possible differences in PC outcomes observed in earlier publications are no longer apparent. Source of Funding: none PD31-08 FLUOROQUINOLONE RESISTANCE IN THE RECTAL CARRIAGE OF MEN IN AN ACTIVE SURVEILLANCE COHORT Jason Cohen*, Patricia Landis, Bruce Trock, Hiten Patel, Edward Schaeffer, Ballentine Carter, Baltimore, MD INTRODUCTION AND OBJECTIVES: A major complication of trans-rectal ultrasound guided prostate biopsies (TRUSB) is infection of the genitourinary system and sepsis, despite antibiotic prophylaxis. Fluoroquinolones are widely accepted as a standard for prophylaxis prior to prostate biopsies. However, a substantial minority of men have been found to have bacteria in the rectal carriage resistant to fluoroquinolones. Targeted antimicrobial prophylaxis with rectal swab cultures to identify fluoroquinolone resistant bacteria has been reported to reduce rates of infection complications post TRUSB. We evaluated the rate of fluo- roquinolone resistance in a large active surveillance cohort with attention to factors predisposing to resistance and changes in resistance over time. METHODS: We evaluated 354 men with prostate cancer on active surveillance that returned for follow-up and underwent a rectal swab for assessment of fluoroquinolone resistance at 6 month intervals. Age, prostate volume, comorbidities, the prior number of prostate bi- opsies and status of past swabs were covariates in a multivariable lo- gistic regression analysis examining the outcome of fluoroquinolone resistance. RESULTS: Of 354 men in the cohort that had a rectal swab, 85 (24%) were found to have fluoroquinolone resistance on at least one swab. Preliminary results demonstrated no significant differ- ence in age, race, PSA, prostate volume, hypertension, dyslipide- mia, heart disease, prior number of prostate biopsies, or time between recent biopsy and the swab among men with vs. without resistance. The relative risk of fluoroquinolone resistance was 2.4 times higher among men with diabetes (54.2% resistant) compared to those without (22.9% resistant); p¼<0.001. Of 21 men who had fluoroquinolone resistance on the first swab and had a second swab, 16 (76%) were found to have resistance on the second swab (median time between swabs: 6.7 months), and of 97 men who had flora sensitive on the first swab and had a second swab, 8 (8%) were found to have resistance on the second swab (median time between swabs 6.8 months). CONCLUSIONS: These data add to the evidence that a sub- stantial minority of men carry rectal flora resistant to fluoroquinolones, and that diabetes is a risk factor for resistance. Initial results demon- strate that resistance patterns change over time in some men. Source of Funding: none PD31-09 INSTITUTIONAL MODIFICATION OF ANTIBIOTIC PROPHYLAXIS PROTOCOL REDUCES INFECTIOUS COMPLICATIONS FOLLOWING TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY Harras Zaid, Chad Ritch*, Daniel Sun, Nashville, TN; Kirk Keegan, San Antonio, TX; Jacob Ark, Roger Dmochowski, David Penson, Sam Chang, Daniel Barocas, Nashville, TN; Michael Cookson, Oklahoma City, OK INTRODUCTION AND OBJECTIVES: There has been an in- crease in microbial resistance to quinolone antibiotics and subsequent rise in infectious complications following transrectal ultrasound guided prostate biopsy (TRUS pBx) in recent years. We sought to describe post-TRUS pBx infectious complications at Vanderbilt and compare our historic rates to a contemporary series following an institutional effort to modify our standard antibiotic prophylaxis protocol based on our local antibiogram. METHODS: We performed a retrospective comparison of a historic cohort of men between 2008-2010 who underwent TRUS pBx following antibiotic prophylaxis with at least 3 days of peri-procedural fluoroquinolone (standard antibiotic protocol - SP), versus a contem- porary cohort of men between 2011-2013 who underwent prophylaxis with single dose ceftriaxone or gentamicin plus a single dose of oral fluoroquinolone at the time of biopsy (modified antibiotic protocol - MP). All men who underwent TRUS pBx during these time periods were included. Infectious complications were extracted from the patient chart. Univariate and multivariate statistical analyses were performed to determine significant predictors of infectious complications, in particular use of the SP versus MP. RESULTS: A total 2003 patients were included (1175 SP and 828 MP). Age, history of quinolone use, biopsy setting (operating room vs. outpatient), diabetic status, and number of previous biopsies was similar between the two groups. In the SP group, there were 75 infec- tious complications (6.1%) compared to 18 (2.2%) in the MP group (p < 0.05). 48% and 33% of cultures were fluoroquinolone resistant, respectively. On multivariate analysis, previous quinolone use and TRUS pBx performed in the operating room predicted higher infection rates (OR 1.93 and 2.00, respectively, p < 0.05). Furthermore, patients who underwent TRUS pBx with the MP had a significantly lower likeli- hood of infectious complications (OR 0.22, p < 0.05) when controlling for other known factors influencing infections. CONCLUSIONS: Institutional modification of our antibiotic prophylaxis protocol reduced the risk of infectious complications in men undergoing TRUS prostate biopsy. Source of Funding: None PD31-10 HORMONAL CHANGES AFTER LOCALIZED PROSTATE CANCER TREATMENT. COMPARISON BETWEEN EXTERNAL BEAM RADIATION THERAPY AND RADICAL PROSTATECTOMY Jacques Planas*, Xavier Maldonado, Ana Celma, Jose Placer, Carles Salvador, Enrique Trilla, David Lorente, Juan Morote, Barcelona, Spain INTRODUCTION AND OBJECTIVES: There is uncertainty in the literature regarding the role that prostate may play as an active endocrine organ and its influence on the hypothalamic pituitary axis. Some studies have investigated the serum hormonal changes in prostate cancer (PCa) patients after radical prostatectomy (RP) or after external beam radiation therapy (EBRT), but no studies have compared both treatments in terms of serum hormonal changes. The aim of our study was to determine the influence of RP and EBRT on the hypothalamic pituitary axis of 117 men with clinically localized PCa treated with RP or EBRT exclusively (without neo- adjuvant or adjuvant androgen deprivation therapy). e834 THE JOURNAL OF UROLOGY â Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
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Transcript of PD31-08 FLUOROQUINOLONE RESISTANCE IN THE RECTAL CARRIAGE OF MEN IN AN ACTIVE SURVEILLANCE COHORT
e834 THE JOURNAL OF UROLOGY� Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
RESULTS: There were 333 (17.7%) men who had AOexposure. AO exposed men were younger (median 59 vs. 62years), had lower preoperative PSA (5.8 vs. 6.7 ng/mL) and clinicalstage (25 vs. 39% palpable), and higher BMI (28.2 vs. 27.6 kg/m2),all p<0.01. Biopsy GS did not differ. Pathologic GS, rate of positivemargins and positive lymph nodes, and extracapsular extension didnot differ, however men with AO exposure had a lower rate ofseminal vesicle invasion (7.0 vs. 10.9%,p¼0.04). At a medianfollow-up of 85 months, 702 (37.4%) of patients had BCR, 78(4.1%) had metastases, and 39 (2.1%) died from PC. On multi-variable analysis, AO exposure was not associated with BCR,metastases, or PC mortality.
CONCLUSIONS: In this cohort of PC patients treated withRP, AO exposure was not associated with worse preoperativecharacteristics such as elevated PSA or biopsy GS, nor was itassociated with worse postoperative long-term outcomes of me-tastases or PC death. Thus, as the data on AO exposed menmatures, possible differences in PC outcomes observed in earlierpublications are no longer apparent.
Source of Funding: none
PD31-08FLUOROQUINOLONE RESISTANCE IN THE RECTAL CARRIAGEOF MEN IN AN ACTIVE SURVEILLANCE COHORT
Jason Cohen*, Patricia Landis, Bruce Trock, Hiten Patel,Edward Schaeffer, Ballentine Carter, Baltimore, MD
INTRODUCTION AND OBJECTIVES: A major complicationof trans-rectal ultrasound guided prostate biopsies (TRUSB) isinfection of the genitourinary system and sepsis, despite antibioticprophylaxis. Fluoroquinolones are widely accepted as a standardfor prophylaxis prior to prostate biopsies. However, a substantialminority of men have been found to have bacteria in the rectalcarriage resistant to fluoroquinolones. Targeted antimicrobialprophylaxis with rectal swab cultures to identify fluoroquinoloneresistant bacteria has been reported to reduce rates of infectioncomplications post TRUSB. We evaluated the rate of fluo-roquinolone resistance in a large active surveillance cohort withattention to factors predisposing to resistance and changes inresistance over time.
METHODS: We evaluated 354 men with prostate cancer onactive surveillance that returned for follow-up and underwent a rectalswab for assessment of fluoroquinolone resistance at 6 month intervals.Age, prostate volume, comorbidities, the prior number of prostate bi-opsies and status of past swabs were covariates in a multivariable lo-gistic regression analysis examining the outcome of fluoroquinoloneresistance.
RESULTS: Of 354 men in the cohort that had a rectal swab,85 (24%) were found to have fluoroquinolone resistance on at leastone swab. Preliminary results demonstrated no significant differ-ence in age, race, PSA, prostate volume, hypertension, dyslipide-mia, heart disease, prior number of prostate biopsies, or timebetween recent biopsy and the swab among men with vs. withoutresistance. The relative risk of fluoroquinolone resistance was 2.4times higher among men with diabetes (54.2% resistant) comparedto those without (22.9% resistant); p¼<0.001. Of 21 men who hadfluoroquinolone resistance on the first swab and had a secondswab, 16 (76%) were found to have resistance on the second swab(median time between swabs: 6.7 months), and of 97 men who hadflora sensitive on the first swab and had a second swab, 8 (8%)were found to have resistance on the second swab (median timebetween swabs 6.8 months).
CONCLUSIONS: These data add to the evidence that a sub-stantial minority of men carry rectal flora resistant to fluoroquinolones,and that diabetes is a risk factor for resistance. Initial results demon-strate that resistance patterns change over time in some men.
Source of Funding: none
PD31-09INSTITUTIONAL MODIFICATION OF ANTIBIOTICPROPHYLAXIS PROTOCOL REDUCES INFECTIOUSCOMPLICATIONS FOLLOWING TRANSRECTAL ULTRASOUNDGUIDED PROSTATE BIOPSY
Harras Zaid, Chad Ritch*, Daniel Sun, Nashville, TN; Kirk Keegan, SanAntonio, TX; Jacob Ark, Roger Dmochowski, David Penson,Sam Chang, Daniel Barocas, Nashville, TN; Michael Cookson,Oklahoma City, OK
INTRODUCTION AND OBJECTIVES: There has been an in-crease in microbial resistance to quinolone antibiotics and subsequentrise in infectious complications following transrectal ultrasound guidedprostate biopsy (TRUS pBx) in recent years. We sought to describepost-TRUS pBx infectious complications at Vanderbilt and compare ourhistoric rates to a contemporary series following an institutional effort tomodify our standard antibiotic prophylaxis protocol based on our localantibiogram.
METHODS: We performed a retrospective comparison of ahistoric cohort of men between 2008-2010 who underwent TRUS pBxfollowing antibiotic prophylaxis with at least 3 days of peri-proceduralfluoroquinolone (standard antibiotic protocol - SP), versus a contem-porary cohort of men between 2011-2013 who underwent prophylaxiswith single dose ceftriaxone or gentamicin plus a single dose of oralfluoroquinolone at the time of biopsy (modified antibiotic protocol - MP).All men who underwent TRUS pBx during these time periods wereincluded. Infectious complications were extracted from the patient chart.Univariate and multivariate statistical analyses were performed todetermine significant predictors of infectious complications, in particularuse of the SP versus MP.
RESULTS: A total 2003 patients were included (1175 SP and828 MP). Age, history of quinolone use, biopsy setting (operating roomvs. outpatient), diabetic status, and number of previous biopsies wassimilar between the two groups. In the SP group, there were 75 infec-tious complications (6.1%) compared to 18 (2.2%) in the MP group (p <
0.05). 48% and 33% of cultures were fluoroquinolone resistant,respectively. On multivariate analysis, previous quinolone use andTRUS pBx performed in the operating room predicted higher infectionrates (OR 1.93 and 2.00, respectively, p < 0.05). Furthermore, patientswho underwent TRUS pBx with the MP had a significantly lower likeli-hood of infectious complications (OR 0.22, p < 0.05) when controllingfor other known factors influencing infections.
CONCLUSIONS: Institutional modification of our antibioticprophylaxis protocol reduced the risk of infectious complications in menundergoing TRUS prostate biopsy.
Source of Funding: None
PD31-10HORMONAL CHANGES AFTER LOCALIZED PROSTATECANCER TREATMENT. COMPARISON BETWEEN EXTERNALBEAM RADIATION THERAPY AND RADICAL PROSTATECTOMY
Jacques Planas*, Xavier Maldonado, Ana Celma, Jose Placer,Carles Salvador, Enrique Trilla, David Lorente, Juan Morote, Barcelona,Spain
INTRODUCTION AND OBJECTIVES: There is uncertainty inthe literature regarding the role that prostate may play as an activeendocrine organ and its influence on the hypothalamic pituitary axis.Some studies have investigated the serum hormonal changes inprostate cancer (PCa) patients after radical prostatectomy (RP) or afterexternal beam radiation therapy (EBRT), but no studies have comparedboth treatments in terms of serum hormonal changes.
The aim of our study was to determine the influence of RP andEBRT on the hypothalamic pituitary axis of 117 men with clinicallylocalized PCa treated with RP or EBRT exclusively (without neo-adjuvant or adjuvant androgen deprivation therapy).
