Korean J Urol.  2015 May;56(5):346-350. 10.4111/kju.2015.56.5.346.

Infection after transrectal ultrasound-guided prostate biopsy

• Lee SJ

• KMID: 2155313
• DOI: http://doi.org/10.4111/kju.2015.56.5.346

Abstract

Infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-Bx) appear to be increasing, which reflects the high prevalence of antibiotic-resistant strains of Enterobacteriaceae. Identifying patients at high risk for antibiotic resistance with history taking is an important initial step. Targeted prophylaxis with a prebiopsy rectal swab culture or augmented antibiotic prophylaxis can be considered for patients at high risk of antibiotic resistance. If infectious complications are suspected, the presence of urosepsis should be evaluated and adequate antibiotic treatment should be started immediately.

Keyword

Biopsy; Infection; Prostate

MeSH Terms

Anti-Bacterial Agents/therapeutic use
Antibiotic Prophylaxis
Biopsy/*adverse effects
Drug Resistance, Bacterial
Escherichia coli Infections/drug therapy/*prevention & control
Humans
Male
Prostate/*pathology
*Ultrasound, High-Intensity Focused, Transrectal
Urinary Tract Infections/*drug therapy/microbiology
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Flow chart to choose antibiotic prophylaxis for transrectal prostate biopsy. *Alternative antibiotics may be recommended in regions where the rate of fluoroquinolone resistance is high, but levels of evidence from clinical studies are not high.

Reference

1. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011; 186:1830–1834.

2. Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH, et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol. 2013; 189:1 Suppl. S12–S17.

3. Hadway P, Barrett LK, Waghorn DJ, Hasan K, Bdesha A, Haldar N, et al. Urosepsis and bacteraemia caused by antibioticresistant organisms after transrectal ultrasonography-guided prostate biopsy. BJU Int. 2009; 104:1556–1558.

4. Hedelin H, Claesson BE, Wilpart A. Febrile reactions after transrectal ultrasound-guided prostatic biopsy: a retrospective study. Scand J Urol Nephrol. 2011; 45:393–396.

5. Mosharafa AA, Torky MH, El Said WM, Meshref A. Rising incidence of acute prostatitis following prostate biopsy: fluoroquinolone resistance and exposure is a significant risk factor. Urology. 2011; 78:511–514.

6. Zaytoun OM, Vargo EH, Rajan R, Berglund R, Gordon S, Jones JS. Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment. Urology. 2011; 77:1035–1041.

7. Zani EL, Clark OA, Rodrigues Netto N Jr. Antibiotic prophylaxis for transrectal prostate biopsy. Cochrane Database Syst Rev. 2011; (5):CD006576.

8. Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008; 179:1379–1390.

9. Feliciano J, Teper E, Ferrandino M, Macchia RJ, Blank W, Grunberger I, et al. The incidence of fluoroquinolone resistant infections after prostate biopsy--are fluoroquinolones still effective prophylaxis? J Urol. 2008; 179:952–955.

10. Johnson L, Sabel A, Burman WJ, Everhart RM, Rome M, MacKenzie TD, et al. Emergence of fluoroquinolone resistance in outpatient urinary Escherichia coli isolates. Am J Med. 2008; 121:876–884.

11. Lee SJ, Lee DS, Choe HS, Shim BS, Kim CS, Kim ME, et al. Antimicrobial resistance in community-acquired urinary tract infections: results from the Korean Antimicrobial Resistance Monitoring System. J Infect Chemother. 2011; 17:440–446.

12. Liss MA, Chang A, Santos R, Nakama-Peeples A, Peterson EM, Osann K, et al. Prevalence and significance of fluoroquinolone resistant Escherichia coli in patients undergoing transrectal ultrasound guided prostate needle biopsy. J Urol. 2011; 185:1283–1288.

13. Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH, et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol. 2010; 183:963–968.

14. Young JL, Liss MA, Szabo RJ. Sepsis due to fluoroquinoloneresistant Escherichia coli after transrectal ultrasound-guided prostate needle biopsy. Urology. 2009; 74:332–338.

15. American Urological Association. AUA/SUNA white paper on the incidence, prevention and treatment of complications related to prostate needle biopsy [Internet]. Linthicum, MD: American Urological Association;cited 2013 Feb 22. Available from: https://www.auanet.org/resources/white-paper-onthe-incidence-prevention-and-treatment-of-complicationsrelated-to-prostate-needle-biopsy.cfm.

16. Choi JW, Kim TH, Chang IH, Kim KD, Moon YT, Myung SC, et al. Febrile urinary tract infection after prostate biopsy and quinolone resistance. Korean J Urol. 2014; 55:660–664.

17. Kim SJ, Kim SI, Ahn HS, Choi JB, Kim YS, Kim SJ. Risk factors for acute prostatitis after transrectal biopsy of the prostate. Korean J Urol. 2010; 51:426–430.

18. Park DS, Hwang JH, Choi DK, Gong IH, Hong YK, Park S, et al. Control of infective complications of transrectal prostate biopsy. Surg Infect (Larchmt). 2014; 15:431–436.

19. Wagenlehner FM, van Oostrum E, Tenke P, Tandogdu Z, Cek M, Grabe M, et al. Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Eur Urol. 2013; 63:521–527.

20. Shigemura K, Matsumoto M, Tanaka K, Yamashita M, Arakawa S, Fujisawa M. Efficacy of combination use of Betalactamase inhibitor with penicillin and fluoroquinolones for antibiotic prophylaxis in transrectal prostate biopsy. Korean J Urol. 2011; 52:289–292.

21. Togo Y, Kubo T, Taoka R, Hiyama Y, Uehara T, Hashimoto J, et al. Occurrence of infection following prostate biopsy procedures in Japan: Japanese Research Group for Urinary Tract Infection (JRGU) - a multi-center retrospective study. J Infect Chemother. 2014; 20:232–237.

22. Tsai YS, Chen CH, Jou YC, Yang WH, Chang CC, Tzai TS. Febrile infection in post-prostate biopsy: results of a ten-year single-institution study in South Taiwan. Surg Infect (Larchmt). 2014; 15:24–28.

23. Cam K, Kayikci A, Akman Y, Erol A. Prospective assessment of the efficacy of single dose versus traditional 3-day antimicrobial prophylaxis in 12-core transrectal prostate biopsy. Int J Urol. 2008; 15:997–1001.

24. Carignan A, Roussy JF, Lapointe V, Valiquette L, Sabbagh R, Pepin J. Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis? Eur Urol. 2012; 62:453–459.

25. Bang JH, Choe HS, Lee DS, Lee SJ, Cho YH. Microbiological characteristics of acute prostatitis after transrectal prostate biopsy. Korean J Urol. 2013; 54:117–122.

26. Shigehara K, Miyagi T, Nakashima T, Shimamura M. Acute bacterial prostatitis after transrectal prostate needle biopsy: clinical analysis. J Infect Chemother. 2008; 14:40–43.

27. Campeggi A, Ouzaid I, Xylinas E, Lesprit P, Hoznek A, Vordos D, et al. Acute bacterial prostatitis after transrectal ultrasoundguided prostate biopsy: epidemiological, bacteria and treatment patterns from a 4-year prospective study. Int J Urol. 2014; 21:152–155.

28. Williamson DA, Roberts SA, Paterson DL, Sidjabat H, Silvey A, Masters J, et al. Escherichia coli bloodstream infection after transrectal ultrasound-guided prostate biopsy: implications of fluoroquinolone-resistant sequence type 131 as a major causative pathogen. Clin Infect Dis. 2012; 54:1406–1412.

29. Ozden E, Bostanci Y, Yakupoglu KY, Akdeniz E, Yilmaz AF, Tulek N, et al. Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy. Urology. 2009; 74:119–123.

30. Minamida S, Satoh T, Tabata K, Kimura M, Tsumura H, Kurosaka S, et al. Prevalence of fluoroquinolone-resistant Escherichia coli before and incidence of acute bacterial prostatitis after prostate biopsy. Urology. 2011; 78:1235–1239.

31. Taylor AK, Zembower TR, Nadler RB, Scheetz MH, Cashy JP, Bowen D, et al. Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol. 2012; 187:1275–1279.

32. Taylor S, Margolick J, Abughosh Z, Goldenberg SL, Lange D, Bowie WR, et al. Ciprofloxacin resistance in the faecal carriage of patients undergoing transrectal ultrasound guided prostate biopsy. BJU Int. 2013; 111:946–953.

33. Akduman B, Akduman D, Tokgoz H, Erol B, Turker T, Ayoglu F, et al. Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms. Urology. 2011; 78:250–255.

34. Durham LK, Ge M, Cuccia AJ, Quinn JP. Modeling antibiotic resistance to project future rates: quinolone resistance in Escherichia coli. Eur J Clin Microbiol Infect Dis. 2010; 29:353–356.

35. Yagci D, Yoruk F, Azap A, Memikoglu O. Prevalence and risk factors for selection of quinolone-resistant Escherichia coli strains in fecal flora of patients receiving quinolone therapy. Antimicrob Agents Chemother. 2009; 53:1287–1289.