title: Increase of prostate biopsy-related bacteremic complications in southern Finland, 2005-2013: a population-based analysis.
abstract: The most severe manifestations of prostate biopsy complications are bacteremic infections. These complications are increasing alarmingly.
  
  
  
  A retrospective cohort study of 17 183 transrectal prostate biopsies performed at the Helsinki and Uusimaa hospital district in southern Finland during 2005-2013. Biopsies were linked to a database of positive blood cultures, yielding 111 bacteremic cases, and yearly bacteremia rates were determined. By multiple regression analysis, demographic risk factors of the whole biopsy cohort for developing bacteremia or fluoroquinolone (FQ)-resistant bacteremia were studied. Clinical risk factors for bacteremia caused by an FQ-resistant organism and for serious bacteremic outcomes were studied by univariate and multivariate analyzes.
  
  
  
  The average bacteremia rate was 0.7% (111 of 17 183 biopsies) and an increase was observed from 0.5% in 2005 (95% confidence interval (CI): 0.3-0.9) to 1.2% in 2012 (95% CI 0.8-1.8); 53.2% were caused by an FQ-resistant organism. In univariate regression analysis, previous biopsy sessions and increasing calendar year of biopsy associated with the risk of developing bacteremia (odds ratio (OR) 1.232, 95% CI: 1.020-1.488, P=0.030 and OR 1.164, 95% CI: 1.079-1.255, P<0.001, respectively), but only increasing calendar year of biopsy remained statistically significant (OR 1.155, 95% CI: 1.070-1.247, P<0.001) in multivariate analysis. Foreign travel within 3 months was associated with FQ resistance in multivariate analysis (OR 7.158, 95% CI: 1.042 to infinite, P=0.045). The study failed to show any significant clinical risk factors for serious bacteremic outcomes (requiring intensive care, developing deep infection foci or death).
  
  
  
  The postbiopsy bacteremia rate doubled during the study period and half of the cases were caused by FQ-resistant organisms. Recent foreign travel increased the risk for FQ resistance. Future research efforts should be aimed at better identifying risk factors, targeted prophylaxis and reducing the need for biopsies.
authors.affiliation: Department of Urology, Meilahti Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Lahdensuo
authors.affiliation: Department of Urology, Meilahti Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Rannikko
authors.affiliation: Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: V-J
authors.initials: VJ
authors.lastname: Anttila
authors.affiliation: Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Erickson
authors.affiliation: Division of Clinical Microbiology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Pätäri-Sampo
authors.affiliation: Division of Clinical Microbiology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Rautio
authors.affiliation: Department of Urology, Meilahti Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Santti
authors.affiliation: Division of Clinical Microbiology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Tarkka
authors.affiliation: Division of Clinical Microbiology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Vaara
authors.affiliation: Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Huotari
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology*; D001706:Biopsy / Q000009:adverse effects*; D005387:Finland; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones