title: Prevention of sepsis prior to prostate biopsy.
abstract: OBJECTIVE
  Urosepsis is the most feared complication of transrectal prostate biopsy. The incidence may be increasing from <1% to 2%-3% in contemporary series. Historically, fluoroquinolones have been effective antibiotic prophylaxis to prevent infective complications but antibiotic resistance is increasing. The increase in antibiotic resistance may contribute to reported increases in urosepsis and hospitalization after transrectal biopsy. This article will review other methods clinicians may employ to reduce the incidence of infective complications after prostate biopsy.
  
  
  METHODS
  A systematic review of the literature was conducted using literature databases PubMed and Ovid MEDLINE in August 2015 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) criteria.
  
  
  RESULTS
  Effective strategies to reduce infective complications after transrectal prostate biopsy include augmented prophylaxis with other antibiotics, rectal swab culture directed antibiotic prophylaxis or a transperineal biopsy approach. Needle disinfection, minimizing the number of biopsy needles and rectal disinfectants may also be of use. These methods may be of particular utility in patients with risk factors for developing urosepsis such as recent antibiotic use and overseas travel.
  
  
  CONCLUSIONS
  The scientific literature describes various techniques designed to reduce infective complications caused by prostate biopsy. Clinicians should consider incorporating these novel techniques into their contemporary practice.
authors.affiliation: Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia.
authors.forename: Liam
authors.initials: L
authors.lastname: Toner
authors.affiliation: Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia.
authors.forename: Damien M
authors.initials: DM
authors.lastname: Bolton
authors.affiliation: Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia.; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia.; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.; School of Cancer Medicine, La Trobe University, Melbourne, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000295:instrumentation; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D004203:Disinfection / Q000379:methods; D006801:Humans; D008297:Male; D009339:Needles; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D018805:Sepsis / Q000517:prevention & control* / Q000635:transmission
keywords: Biopsy; Complications; Infection; Prostatic neoplasms; Sepsis