Emergency hospital admissions attributable to infective complications of prostate biopsy despite appropriate prophylaxis: need for additional infection prevention strategies?
OBJECTIVE
To report the incidence of emergency admissions attributable to infective complications of transrectal ultrasound-guided prostate biopsy (TGB) and evaluate appropriateness of antimicrobial prophylaxis.


METHODS
Retrospective cross-sectional study of patients undergoing TGB at the North West London Hospitals in 2009-2011. Demographic information of patients who had emergency admission within 30 days of TGB, length of hospital stay and microbiology results were obtained from the hospital's information system, medical records and laboratory information system. All patients received ciprofloxacin and amikacin prophylaxis.


RESULTS
1,419 TGB were performed in 1,276 patients. Forty-eight (3.3 %) patients had emergency admissions. Thirty-three (2.3 %) admissions were due to complications from TGB, while 15 (1 %) were for unrelated reasons. 30/33 (90 %, overall 2.1 %) of admissions from TGB complications were due to confirmed infections or systemic inflammatory response syndrome (SIRS). The rest were admitted with urinary retention. Admission rates due to TGB complications and infection/SIRS remained consistent over the 3 years (2009: TGB complications-2 %, TGB infection/SIRS-1.8 %; 2010: TGB complications-2.4 %, TGB infections/SIRS-2.2 %; 2011: TGB complications-2.6 %, TGB infection/SIRS-2.4 %; P > 0.05). All 11 cases with bacteraemia were caused by ciprofloxacin-resistant but amikacin-susceptible E. coli.


CONCLUSIONS
We observed a consistent rate of emergency admissions for complications following TGB; 90 % of these were due to infections. Ciprofloxacin-resistant but amikacin-sensitive E. coli was isolated in all bacteriologically confirmed infections. These results suggest that infective complications of TGB cannot be altogether eliminated despite appropriate antimicrobial prophylaxis. Therefore, additional strategies for reduction in biopsy-related admissions due to infections have to be considered.
Department of Microbiology, North West London Hospitals NHS Trust, Watford Road, London, HA1 3UJ, UK.
G
G
Gopal Rao
Deepak
D
Batura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D004630:Emergencies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects*; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011467:Prostate / Q000473:pathology*; D012007:Rectum / Q000382:microbiology; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology* / Q000209:etiology; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D000583:Amikacin