Urogenit Tract Infect.  2016 Apr;11(1):17-24. 10.14777/uti.2016.11.1.17.

Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study

• Hwang EC
• Yu HS
• Jung SI
• Kwon DD
• Lee SJ
• Kim TH
• Chang IH
• Yoon H
• Shim B
• Kim KH
• Lee D
• Huh JS
• Lim DH
• Jo WJ
• Min SK
• Lee G
• Kim KH
• Kim TH
• Lee SY
• Yang SO
• Chung JM
• Lee SD
• Han CH
• Bae SR
• Choe HS
• Lee SJ
• Chung H
• Na YG
• Yang SW
• Park SW
• Kim YH
• Kim TH
• Cho WY
• Han JH
• Cho YH
• Ha US
• Park HJ
• The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII)

• KMID: 2319424
• DOI: http://doi.org/10.14777/uti.2016.11.1.17

Abstract

PURPOSE
Recent studies have highlighted an increasing trend of infectious complications due to fluoroquinolone-resistant organisms among men undergoing transrectal prostate biopsy. This study evaluated the current incidence of infective complications after trans-rectal prostate biopsy for identification of risk factors in Korean men who received fluoroquinolone prophylaxis.
MATERIALS AND METHODS
A prospective, multicenter study was conducted in Korea from January to December 2015. Prostate biopsies performed with fluoroquinolone prophylaxis during 3 months in each center were included. A pre-biopsy questionnaire was used for identification of patient characteristics. Clinical variables including underlying disease, antibiotic prophylaxis, enema, povidone-iodine cleansing of the rectum, and infectious complications were evaluated. The primary outcome was the post-biopsy infection rate after fluoroquinolone prophylaxis. Univariable and multivariable analyses were used for identification of risk factors for infectious complications.
RESULTS
The study included 827 patients, of whom 93 patients (11.2%) reported receiving antibiotics in the previous 6 months and 2.5% had a history of prostatitis. The infectious complication rate was 2.2%. Post-biopsy sepsis was reported in 2 patients (0.2%). In multivariable analysis predictors of post-biopsy sepsis included person performing biopsy (adjusted odds ratio [OR], 4.05; 95% confidence interval [CI], 1.31-12.5; p=0.015) and operation history within 6 months (adjusted OR, 5.65; 95% CI, 1.74-18.2; p=0.004).
CONCLUSIONS
The post-prostate biopsy infectious complication rate in this study was 2.2%. Person performing biopsy (non-urologists) and recent operation history were independent risk factors for infectious complications after trans-rectal prostate biopsy.

Keyword

Biopsy; Escherichia coli; Fluoroquinolones; Infection; Prostate

MeSH Terms

Anti-Bacterial Agents
Antibiotic Prophylaxis
Biopsy*
Enema
Escherichia coli
Fluoroquinolones
Humans
Incidence
Korea
Male
Odds Ratio
Povidone-Iodine
Prospective Studies*
Prostate*
Prostatitis
Rectum
Risk Factors
Sepsis
Anti-Bacterial Agents
Fluoroquinolones
Povidone-Iodine

Reference

References

1. Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. Eur Urol. 2013; 64:876–92.

2. Drusano GL, Preston SL, Van Guilder M, North D, Gombert M, Oefelein M, et al. A population pharmacokinetic analysis of the penetration of the prostate by levofloxacin. Antimicrob Agents Chemother. 2000; 44:2046–51.

3. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. European Association of Urology. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014; 65:124–37.

4. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011; 186:1830–4.

5. 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):S12–7.

6. Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schroder FH, Roobol MJ. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol. 2012; 61:1110–4.

7. 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; 74:119–23.

8. Williamson DA, Barrett LK, Rogers BA, Freeman JT, Hadway P, Paterson DL. Infectious complications following transrectal ultrasound-guided prostate biopsy: new challenges in the era of multidrug-resistant Escherichia coli. Clin Infect Dis. 2013; 57:267–74.

9. Levy SB. The 2000 Garrod lecture. Factors impacting on the problem of antibiotic resistance. J Antimicrob Chemother. 2002; 49:25–30.

10. Hillelsohn JH, Duty B, Blute ML Jr, Okhunov Z, Kashan M, Moldwin R, et al. Variability of transrectal ultrasound-guided prostate biopsy prophylactic measures. Can J Urol. 2012; 19:6573–7.

11. Steensels D, Slabbaert K, De Wever L, Vermeersch P, Van Poppel H, Verhaegen J. Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy–should we reassess our practices for antibiotic prophylaxis? Clin Microbiol Infect. 2012; 18:575–81.

12. Roberts MJ, Williamson DA, Hadway P, Doi SA, Gardiner RA, Paterson DL. Baseline prevalence of antimicrobial resistance and subsequent infection following prostate biopsy using empirical or altered prophylaxis: a bias-adjusted metaanalysis. Int J Antimicrob Agents. 2014; 43:301–9.

13. 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; 187:1275–9.

14. Cho YH, Jung SI, Chung HS, Yu HS, Hwang EC, Kim SO, et al. Antimicrobial susceptibilities of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in health care-associated urinary tract infection: focus on susceptibility to fosfomycin. Int Urol Nephrol. 2015; 47:1059–66.

15. Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ. Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008; 179:1379–90.

16. Hwang EC, Jung SI, Seo YH, Jeong SH, Kwon DD, Park K, et al. Risk factors for and prophylactic effect of povidone-iodine rectal cleansing on infectious complications after prostate biopsy: a retrospective cohort study. Int Urol Nephrol. 2015; 47:595–601.

17. 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; 15:431–6.

18. 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; 55:660–4.

19. Wagenlehner FM, van Oostrum E, Tenke P, Tandogdu Z, Cek M, Grabe M, et al. GPIU investigators. 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; 63:521–7.

20. 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; 62:453–9.

21. 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; 179:952–5.

22. Bang JH, Choe HS, Lee DS, Lee SJ, Cho YH. Microbiological characteristics of acute prostatitis after transrectal prostate biopsy. Korean J Urol. 2013; 54:117–22.

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

24. Pu C, Bai Y, Yuan H, Li J, Tang Y, Wang J, et al. Reducing the risk of infection for transrectal prostate biopsy with povidone-iodine: a systematic review and metaanalysis. Int Urol Nephrol. 2014; 46:1691–8.

25. Abughosh Z, Margolick J, Goldenberg SL, Taylor SA, Afshar K, Bell R, et al. A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy. J Urol. 2013; 189:1326–31.

26. 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; 185:1283–8.

27. European Association of Urology. Guidelines on urological infections 2015 [Internet]. Arnhem: European Association of Urology;c2015. [cited 2015 Dec 24]. Available from:. http://uroweb.org/wp-content/uploads/EAU-Guidelines-Urolo. gical-Infections-v2.pdf.

28. Bruyere F, Malavaud S, Bertrand P, Decock A, Cariou G, Doublet JD, et al. Prosbiotate: a multicenter, prospective analysis of infectious complications after prostate biopsy. J Urol. 2015; 193:145–50.