title: Febrile infection in post-prostate biopsy: results of a ten-year single-institution study in South Taiwan.
abstract: BACKGROUND
  Post-biopsy infection is one of the major concerns of urologists and patients for prostate biopsy. Many efforts have been made to reduce the infection rate. We conducted a study at a single institution with the goal of describing the bacteriology and incidence trends of febrile infections following trans-rectal ultrasound (TRUS)-guided biopsy of the prostate.
  
  
  METHODS
  From January 1998 to December 2002 (Period 1 of the study), January 2003 to August 2005 (Period 2), September 2005 to October 2007 (Period 3), and November 2007 to December 2009 (Period 4), 1,406 patients underwent prostate biopsy at our hospital. All biopsies were conducted under TRUS guidance without preparation by enemas. Several steps were taken to reduce infectious complications following biopsy, including a shift to levofloxacin prophylaxis starting from Period 3 of our study and thorough instructions in post-biopsy self-care starting from the beginning of Period 4. The incidence and bacteriology of urinary tract infection (UTI) following the prostate biopsies were reviewed from chart records.
  
  
  RESULTS
  Twenty-eight of 514 (5.4%), 13 of 276 (4.7%) nine of 274 (3.2%), and three of 342 (0.9%) patients had post-biopsy febrile infections during the four periods of the study, respectively. Fifteen of 28 (53.5%), four of 13 (30.8%), five of nine (55.6%), and zero of three patients, respectively, had positive cultures of blood, urine, or both during the four study periods. Escherichia coli was the pathogen isolated most commonly and ampicillin- and fluoroquinolone-resistant strains of this organism were identified at a high frequency. The times to onset of fever after biopsy in the four study periods were 1.5±1.3 d, 3.7±2.7 d, 2.2±1.6 d, and 2.5±0.9 d, respectively.
  
  
  CONCLUSIONS
  Ampicillin- and fluoroquinolone-resistant strains of E. coli were the uropathogenic bacteria identified most commonly after prostate biopsy at our hospital. The incidence of UTI following prostate biopsy can be reduced by explaining instructions for medication and self-care thoroughly to patients undergoing such biopsy.
authors.affiliation: 1 Department of Urology, National Cheng Kung University Hospital , College of Medicine, Tainan, Taiwan .
authors.forename: Yuh-Shyan
authors.initials: YS
authors.lastname: Tsai
authors.forename: Chia-Hong
authors.initials: CH
authors.lastname: Chen
authors.forename: Yeong-Chin
authors.initials: YC
authors.lastname: Jou
authors.forename: Wen-Horng
authors.initials: WH
authors.lastname: Yang
authors.forename: Chien-Chen
authors.initials: CC
authors.lastname: Chang
authors.forename: Tzong-Shin
authors.initials: TS
authors.lastname: Tzai
mesh_terms: D000368:Aged; D001706:Biopsy / Q000009:adverse effects*; D005334:Fever / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D011467:Prostate / Q000601:surgery*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D018084:Ultrasonography, Interventional; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*