title: Sepsis and 'superbugs': should we favour the transperineal over the transrectal approach for prostate biopsy?
abstract: OBJECTIVE
  To determine the rate of hospital re-admission for sepsis after transperineal (TP) biopsy using both local data and worldwide literature, as there is growing interest in TP biopsy as an alternative to transrectal ultrasonography (TRUS)-guided biopsy for patients undergoing repeat prostate biopsy.
  
  
  METHODS
  Pooled prospective databases on TP biopsy from multiple centres in Melbourne were queried for rates of re-admission for infection. A literature review of PubMed and Embase was also conducted using the search terms: 'prostate biopsy, fever, infection, sepsis, septicaemia and complications'.
  
  
  RESULTS
  In all, 245 TP biopsies were performed (111 at Alfred Health, 92 at Epworth Healthcare, 38 at Peter MacCallum Cancer Centre, and four at other institutions). The rate of hospital re-admission for infection was zero. The literature review showed that the rate of sepsis after TRUS biopsy appears to be rising with increasing rates of multi-resistant bacteria found in rectal flora, and is as high as 5%. However, the rate of sepsis from published series of TP biopsy approached zero.
  
  
  CONCLUSIONS
  Both local and international data suggest a negligible rate of sepsis with TP biopsy. This compares to a concerning rise in the rate of sepsis after TRUS biopsy due to the increasing prevalence of multi-resistant bacteria in rectal flora. Although TRUS biopsy is convenient, cheap and quick to perform, we think that TP biopsy should now be offered as an option, not only to patients undergoing repeat prostate biopsy, but to all patients in whom a prostate biopsy is indicated.
authors.affiliation: Alfred Health, Melbourne, VIC, Australia; Epworth Healthcare, Melbourne, VIC, Australia; Cabrini Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia.
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Grummet
authors.forename: Mahesha
authors.initials: M
authors.lastname: Weerakoon
authors.forename: Sean
authors.initials: S
authors.lastname: Huang
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
authors.forename: Mark
authors.initials: M
authors.lastname: Frydenberg
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Moon
authors.forename: Mary
authors.initials: M
authors.lastname: O'Reilly
authors.forename: Declan
authors.initials: D
authors.lastname: Murphy
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods*; D024901:Drug Resistance, Multiple, Bacterial; D004927:Escherichia coli Infections / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D010502:Perineum / Q000382:microbiology / Q000601:surgery; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000382:microbiology / Q000473:pathology*; D012007:Rectum / Q000382:microbiology / Q000601:surgery; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: infection; prostate; sepsis; transperineal biopsy; transrectal biopsy