Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis?

Abstract

BACKGROUND:

An increasing risk of infectious complications following transrectal ultrasound-guided prostate needle biopsy (PNB) has been observed recently in some centers.

OBJECTIVE:

To delineate the risk factors associated with post-PNB bacteremia and/or urinary tract infection (UTI) and determine why this risk has risen over time.

DESIGN, SETTING, AND PARTICIPANTS:

A case-control study in a Canadian tertiary-care center. Cases were all patients who developed bacteremia and/or UTIs after PNB between 2002 and 2011; controls were randomly selected among patients who underwent a PNB without such complications.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

Crude and adjusted odds ratios and their 95% confidence intervals were calculated using logistic regression.

RESULTS AND LIMITATIONS:

A total of 5798 PNBs were performed during the study period, following which there were 48 cases of urinary sepsis (42% with bacteremia). The incidence increased from 0.52 infections per 100 biopsies in 2002-2009 to 2.15 infections per 100 biopsies in 2010-2011 (p<0.001). Escherichia coli was the predominant pathogen (75% of cases). Among 42 patients whose post-PNB infection was caused by aerobic or facultative Gram-negative rods, 22 patients (52%) were infected by pathogens resistant to ciprofloxacin. Independent risk factors for post-PNB infection were diabetes, hospitalization during the preceding month, chronic obstructive pulmonary disease, and performance of the biopsy in 2010-2011. In 2010-2011, the minimal inhibitory concentrations for ciprofloxacin increased compared with 2002-2009 (p<0.03). The major limitation of the study was its retrospective hospital-based nature, which hampered data collection on outpatient antibiotic prescriptions.

CONCLUSIONS:

In the past 2 yr, ciprofloxacin resistance contributed to the increasing incidence of post-PNB infections in our center. Novel antibacterial prophylaxis approaches need to be evaluated.

• Authors: Alex Carignan, Jean-François Roussy, Véronique Lapointe, Louis Valiquette, Robert Sabbagh, Jacques Pépin
• Journal: European urology (Eur Urol) Vol. 62 Issue 3 Pg. 453-9 (Sep 2012) ISSN: 1873-7560 [Electronic] Switzerland
• PMID: 22575912 (Publication Type: Journal Article)
• Copyright: Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Ciprofloxacin

Topics

• Aged
• Anti-Bacterial Agents (administration & dosage)
• Antibiotic Prophylaxis
• Biopsy, Needle (adverse effects)
• Chi-Square Distribution
• Ciprofloxacin (administration & dosage)
• Drug Resistance, Bacterial
• Humans
• Image-Guided Biopsy (adverse effects)
• Incidence
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Predictive Value of Tests
• Prostate (pathology)
• Prostatic Neoplasms (pathology)
• Quebec (epidemiology)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Sepsis (diagnosis, epidemiology, microbiology, prevention & control)
• Tertiary Care Centers
• Time Factors
• Ultrasonography, Interventional (adverse effects)
• Urinary Tract Infections (diagnosis, epidemiology, microbiology, prevention & control)