title: Infection after transrectal ultrasonography-guided prostate biopsy: increased relative risks after recent international travel or antibiotic use.
abstract: Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Septicaemia is the most frequent cause of hospitalization after transtrectal prostate biopsy; fatalities have been reported and the incidence is on the rise. This study shows that men with a history of recent international travel or antibiotic use have up to four times increased risk of septicaemia and hospitalization. When they do occur, infections are usually due to multi-resistant E coli and additional care, e.g. delay before biopsy, different antibiotic prophylaxis or transperineal biopsy, should be considered in these cases. OBJECTIVE • To study the infection rate after prostate biopsy in those who have travelled overseas or used antibiotics in the 4 weeks before biopsy. PATIENTS AND METHODS • A total of 316 men with a mean (range) age of 61 (45-85) years were studied. All had undergone transrectal ultrasonography (TRUS)-guided prostate biopsy after standard antibiotic prophylaxis. • Before their biopsy the patients were risk stratified and a history of recent international travel or antibiotic use was recorded. • Those who suffered sufficiently severe infection/sepsis so as to require hospitalization were identified at the end of the study period. • The characteristics of these patients and the types of infections were explored and the relative risk (RR) of infection after recent travel or antibiotic use was calculated. RESULTS • Of the 316 men, 16 were hospitalized with infection. • The group with (n= 16) and without (n= 300) infection were equivalent in age, prostate-specific antigen level, disease status and number of biopsy cores taken. • Either recent travel or antibiotic use were independent risk factors for infection [travel: 8/16 vs 76/300; P= 0.04; RR 2.7 and antibiotic use: 4/16 vs 20/300; P= 0.025; RR 4]. There was no significant pattern in the countries visited or the type of antibiotic used. • Culture results were positive in 10/16 men, and all cultures grew multiresistant Escherichia coli. The strains were uniformly resistant to ciprofloxacin and amoxycillin, and variably resistant to gentamicin and co-amoxiclav, but nearly all were sensitive to meropenem. • All patients made a full recovery after antibiotic and supportive treatment. CONCLUSIONS • Either recent international travel or antibiotic use are independent risk factors for severe infection after TRUS-guided prostate biopsy. • When infection does occur it should be treated aggressively as the causative agent is usually a multiresistant E. coli.
authors: The Prostate Centre, London, UK. drudaypatel@gmail.com
authors: Uday
authors: U
authors: Patel
authors: Prokar
authors: P
authors: Dasgupta
authors: Peter
authors: P
authors: Amoroso
authors: Ben
authors: B
authors: Challacombe
authors: James
authors: J
authors: Pilcher
authors: Roger
authors: R
authors: Kirby
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy / Q000379:methods; D024901:Drug Resistance, Multiple, Bacterial; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology*; D014195:Travel; D018084:Ultrasonography, Interventional
chemical_list: D000900:Anti-Bacterial Agents