title: Nationwide population based study of infections after transrectal ultrasound guided prostate biopsy.
abstract: OBJECTIVE
  Transrectal ultrasound guided biopsy is the gold standard for detecting prostate cancer but international reports suggest that increasing risks are associated with the procedure. We estimated incidence and risk factors for infection after prostate biopsy as well as 90-day mortality using a nationwide Swedish sample.
  
  
  METHODS
  We performed a population based study of 51,321 men from PCBaSe between 2006 and 2011. Primary outcome measures were dispensed prescriptions of antibiotics for urinary tract infection and hospitalization with a discharge diagnosis of urinary tract infection. Multivariable logistic regression was used to examine risk factors for infection in men who underwent prostate biopsy.
  
  
  RESULTS
  During the 6 months before biopsy the background incidence of urinary tract infection was approximately 2%. Within 30 days after biopsy 6% of the men had a dispensed prescription for urinary tract antibiotics and 1% were hospitalized with infection. The strongest risk factors for an antibiotic prescription were prior infection (OR 1.59, 95% CI 1.45-1.73), high Charlson comorbidity index (OR 1.25, 95% CI 1.11-1.41) and diabetes (OR 1.32, 95% CI 1.17-1.49). Risk of an antibiotic prescription after biopsy decreased from 2006 to 2011 (OR 0.79, 95% CI 0.70-0.90) but the risk of hospital admission increased (OR 2.14, 95% CI 1.58-2.94). No significant increase was observed in 90-day mortality.
  
  
  CONCLUSIONS
  Severe infections with hospitalization after prostate biopsy are increasing in Sweden. The risk of post-biopsy infection is highest in men with a history of urinary tract infection and those with significant comorbidities.
authors.affiliation: Department of Surgical and Perioperative Sciences, Urology, Andrology, Umeå University, Umeå, Sweden. Electronic address: karl-johan.lundstrom@jll.se.
authors.forename: Karl-Johan
authors.initials: KJ
authors.lastname: Lundström
authors.affiliation: Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Linda
authors.initials: L
authors.lastname: Drevin
authors.affiliation: Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Carlsson
authors.affiliation: Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.affiliation: Department of Urology, New York University and Manhattan Veterans Affairs Hospital, New York, New York.
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
authors.affiliation: Department of Surgical and Perioperative Sciences, Urology, Andrology, Umeå University, Umeå, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Stattin
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Bill-Axelson
mesh_terms: D000368:Aged; D002423:Cause of Death; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods* / Q000401:mortality; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology*; D012007:Rectum; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology
keywords: anti-bacterial agents; biopsy; complications; prostate; urinary tract infections