title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Crude and adjusted odds ratios and their 95% confidence intervals were calculated using logistic regression.
  
  
  CONCLUSIONS
  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.affiliation: Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Quebec, Canada. Alex.Carignan@USherbrooke.ca
authors.forename: Alex
authors.initials: A
authors.lastname: Carignan
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Roussy
authors.forename: Véronique
authors.initials: V
authors.lastname: Lapointe
authors.forename: Louis
authors.initials: L
authors.lastname: Valiquette
authors.forename: Robert
authors.initials: R
authors.lastname: Sabbagh
authors.forename: Jacques
authors.initials: J
authors.lastname: Pépin
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D001707:Biopsy, Needle / Q000009:adverse effects; D016009:Chi-Square Distribution; D002939:Ciprofloxacin / Q000008:administration & dosage; D024881:Drug Resistance, Bacterial; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D062606:Tertiary Care Centers; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin