title: The impact of repeat biopsies on infectious complications in men with prostate cancer on active surveillance.
abstract: OBJECTIVE
  Prostate biopsy related infectious complications are associated with significant morbidity. The risk of infectious complications in patients with prostate cancer on active surveillance remains under studied.
  
  
  METHODS
  A total of 591 consecutive men who underwent prostate biopsy were prospectively enrolled in a study evaluating prostate biopsy related complications between January 2011 and January 2012. Of these men 403 were previously diagnosed with prostate cancer and were included in this study. They underwent a 14-core transrectal ultrasound guided prostate biopsy as part of an active surveillance regimen. A nurse contacted all men within 14 days of biopsy, and information was collected on potential complications, antibiotics received and bacterial culture results.
  
  
  RESULTS
  Fourteen patients (3.5%) had infectious complications including 13 requiring hospitalization. Five patients had positive urine cultures, and fluoroquinolone resistant isolates were identified in 4 patients, including 2 with extended spectrum beta-lactamase producing isolates. We evaluated the impact of risk factors including diabetes, benign prostatic hyperplasia and antibiotic regimen. However, only the number of previous prostate biopsies was significantly associated with an increased risk of infectious complications (p = 0.041). For every previous biopsy the odds of an infection increased 1.3 times (OR 1.33, 95% CI 1.01-1.74).
  
  
  CONCLUSIONS
  In men with prostate cancer on active surveillance the number of previous prostate biopsies is associated with a significant risk of infectious complications and every previous biopsy increases the risk of infectious complication. Fluoroquinolone resistant and extended spectrum beta-lactamase producing isolates represent the most commonly identified organisms. Men with prostate cancer on active surveillance should be informed of the risks associated with serial repeat prostate biopsies.
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Behfar
authors.initials: B
authors.lastname: Ehdaie
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Emily
authors.initials: E
authors.lastname: Vertosick
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Spaliviero
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Anna
authors.initials: A
authors.lastname: Giallo-Uvino
authors.affiliation: Department of Medicine, Infectious Diseases Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Ying
authors.initials: Y
authors.lastname: Taur
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Maryellen
authors.initials: M
authors.lastname: O'Sullivan
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Livingston
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: Pramod
authors.initials: P
authors.lastname: Sogani
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Eastham
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Scardino
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Urology, Weill Medical College of Cornell University, New York, New York. Electronic address: touijera@mskcc.org.
authors.forename: Karim
authors.initials: K
authors.lastname: Touijer
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D024881:Drug Resistance, Bacterial; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology*; D019233:Retreatment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000900:Anti-Bacterial Agents
keywords: biopsy; infection; prostatic neoplasms; sepsis; treatment outcome