Acute bacterial prostatitis after transrectal ultrasound‐guided prostate biopsy: Epidemiological, bacteria and treatment patterns from a 4‐year prospective study

Abstract

Abbreviations & AcronymsObjectives: To evaluate the incidence, and clinical and bacterial features of iatrogenic prostatitis within 1 month after transrectal ultrasound-guided biopsy for detection of prostate cancer. Methods: From January 2006 to December 2009, 3000 patients underwent a 21-core transrectal ultrasound-guided prostate biopsy at Henri Mondor Hospital (Créteil, France) and were prospectively followed. All patients had a fluoroquinolone antimicrobial prophylaxis for 7 days. The primary study end-point was to evaluate the incidence of iatrogenic acute prostatitis within 1 month after the biopsy. The secondary end-point was to analyze the clinical and the bacterial features of the prostatitis. Results: Overall, 20 patients of the entire study population (0.67%) had an acute bacterial prostatitis within 2.90 ± 1.77 days (range 1-7 days) after the transrectal ultrasound-guided biopsy. The groups of patients with (n = 20) and without (n = 2980) infection were similar in terms of age, prostate-specific antigen level and prostate volume. Escherichia coli was the only isolated bacteria. The subsequent tests for antibiotic susceptibility showed a 95% resistance for fluroquinolone and amoxicillin. Resistance to amoxiclav, trimethoprimsulfamethoxazole, third generation cephalosporin and amikacin was 70%, 70%, 25% and 5% respectively. No resistance to imipenem was reported. They were all admitted for treatment without the need of intensive care unit referral. Complete recovery was achieved after 21.4 ± 7 days of antibiotic treatment. Conclusions: A fluroquinolone-based regimen still represents an appropriate prophylaxis protocol to minimize the risk of acute prostatitis secondary to prostate biopsy. Patients should be provided the appropriate care soon after the onset of the symptoms. An intravenous third generation cephalosporin or imipenem-based therapy seem to provide satisfying results.

Prostatic inflammation enhances basal-to-luminal differentiation and accelerates initiation of prostate cancer with a basal cell origin

“…First, the bacterial-infection model is not representative of all types of human prostatitis, because many patients with chronic prostatitis and chronic pelvic pain syndrome have no evidence of urinary tract infection (43). In addition, E. coli is not the only source for bacterial infection (39,44,45). Second, transurethral instillation of uropathogenic bacteria usually causes an immediate phase of acute inflammation followed a few months later by a second phase of multifocal chronic inflammation (34).…”

Clinical and microbiological characteristics of spontaneous acute prostatitis and transrectal prostate biopsy-related acute prostatitis: Is transrectal prostate biopsy-related acute prostatitis a distinct acute prostatitis category?

“…The clinical pattern and microbiological characteristics of ABP in patients with prior manipulation of the lower urinary tract has been reported to be different from that of ABP in patients without prior manipulation [2]. TRUS-TRBx is generally accepted as the standard procedure for diagnosing PCa, and direct bacterial seeding from a prostate biopsy is another common cause of ABP [3,7]. Although the incidence of TRUS-TRBx-induced acute prostatitis is low, it is a typically serious complication when it does occur.…”

“…Nevertheless, quinolone is still an effective antibiotic prophylaxis for Bx-ABP [3,16]. In a review of a large number of patients who underwent TRBx, on the basis of low incidence of Bx-ABP, the authors concluded that a quinolone-based regimen still represents an appropriate prophylaxis protocol to minimize the risk of Bx-ABP [3].…”

“…Transrectal ultrasound-guided prostate biopsy (TRUS-TRBx) is generally accepted as the standard procedure for diagnosing prostate cancer (PCa) [3]. The incidence of ABP resulting from TRBx (Bx-ABP) has increased during the last 10 years, possibly as a result of an increase in quinolone-resistant Escherichia coli in the community [4e6].…”

Editorial Comment to Acute bacterial prostatitis after transrectal ultrasound‐guided prostate biopsy: Epidemiological, bacterial and treatment patterns from a 4‐year prospective study

“…No resistance to imipenem was reported. 1 The authors raised an important question, "Is fluoroquinolone still an appropriate antibiotic prophylaxis for prostate biopsy?" On the basis of low incidence of infectious complications after biopsy, they concluded that the choice of fluoroquinolone is appropriate with regards to local bacteriological epidemiology; they explained that modifying the prophylaxis for a larger spectrum antibiotic could raise the resistance profile of the incriminating bacteria and subsequently cause more severe prostatitis.…”