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No answers yet for prostate biopsy infection

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Anne Ford

January 2016—When Kimberle Chapin, MD, learned in 2014 that Lifespan’s urologists in Rhode Island wanted to begin screening transrectal prostate needle biopsy specimens for fluoroquinolone-resistant Escherichia coli, her first reaction was: “What?”

Turns out that the urologists had heard of a new safety initiative being promoted by the CMS Surgical Care Improvement Project, one that could in time become a quality measure: prophylactically administering targeted antimicrobials for prostate biopsy based on rectal swab culture.

“It was going to be on a checklist, so everyone got concerned about how this was going to be accomplished,” says Dr. Chapin, who is director of microbiology and infectious diseases molecular diagnostics at Lifespan Academic Medical Centers and professor of medicine and pathology at Brown Univ­ersity’s Warren Alpert Medical School in Providence. “I’m like, ‘Okay, we don’t even have a standardized way to screen for that. That’s not doable in our lab outside of a major validation.’”

As Dr. Chapin told the story in a Nov. 4, 2015 Association for Molecular Pathology workshop sponsored by GeneWeave, titled “What’s Missing in Molecular Diagnostics,” that conundrum—must screen, can’t screen—led her and her laboratory down a rabbit hole of trying to follow the CMS initiative while maintaining efficient testing processes and not contributing to antibiotic resistance. As she noted in her remarks, and in an interview with CAP TODAY, the experience was frustrating but illuminating.

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