Increasing Risk of Infectious Complications After Transrectal Ultrasound–Guided Prostate Biopsies: Time to Reassess Antimicrobial Prophylaxis?

Carignan, Alex; Roussy, Jean-François; Lapointe, Véronique; Valiquette, Louis; Sabbagh, Robert; Pépin, Jacques

doi:10.1016/j.eururo.2012.04.044

Cited by 251 publications

(245 citation statements)

References 25 publications

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“…It may be argued that this rate is low. However, due to the accumulating bulk of literature reporting on increasing rate of infectious and potentially lethal complications following PB [17][18][19], we believe this rate is clinically significant. In addition, reducing even a small proportion of PBs translates into a significant cost reduction, considering the millions of procedures that are routinely performed worldwide every year.…”

Section: A Gallotta Et Al Cancer Treatment and Research Communicatimentioning

confidence: 99%

Clinical validation of the iXip index in avoiding unnecessary prostate biopsy: Results from a prospective multicenter study involving 426 patients

Gallotta¹,

Giannarini

Laurini³

et al. 2017

Cancer Treatment and Research Communications

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Section: A Gallotta Et Al Cancer Treatment and Research Communicatimentioning

confidence: 99%

Clinical validation of the iXip index in avoiding unnecessary prostate biopsy: Results from a prospective multicenter study involving 426 patients

Gallotta¹,

Giannarini

Laurini³

et al. 2017

Cancer Treatment and Research Communications

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“…A Canadian, retrospective study of 5798 PB patients reported a hospitalization rate of 0.5%, all due to infection. Independent predictors were a more recent year of biopsy (OR: 4.74, p<0.001), diabetes (OR: 4.78, p=0.01), chronic obstructive pulmonary disease (OR: 5.66, p=0.005) and a history of recent hospitalization (OR: 8.83, p=0.03) 60 . In men from the Rotterdam section of the ERSPC, the hospitalization rate within 14 days after biopsy was 0.8%, primarily due to infection (81%).…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

“…In this scenario, patients with biopsy-related bacterial acute prostatitis have a higher risk of sepsis when compared to those with spontaneous acute prostatitis, probably due to a different pathogenic bacterial strain among the two groups 61 . Furthermore, medical comorbidities (particularly diabetes or metabolic syndrome) and older age are independent predictors increasing the risk of infections and sepsis 45,58,60,62 . A previous history of prostatitis, antibiotics within 6 months before PB, and non-adherence to antibiotic prophylaxis represent other risk factors 46 .…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

“…Most infections are self-limiting and can be managed in the outpatient setting 7,45 . However, the incidence of more serious infectious complications requiring hospitalization has dramatically increased over time 2,15,[58][59][60] , with fluoroquinolone-resistant (FQR) Escherichia Coli as the most recognized risk factor 2,45,47,[49][50][51]53 . In this scenario, patients with biopsy-related bacterial acute prostatitis have a higher risk of sepsis when compared to those with spontaneous acute prostatitis, probably due to a different pathogenic bacterial strain among the two groups 61 .…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

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Complications After Systematic, Random, and Image-guided Prostate Biopsy

et al. 2017

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Evidence Synthesis: The most frequent complication after PB is minor and self-limiting bleeding (hematuria and hematospermia), irrespective of the biopsy approach. Occurrence of rectal bleeding was comparable among traditional TRUS-guided and image-guided PB. Almost 25% of patients experience lower urinary tract symptoms, but only a few have urinary retention, with higher rates after transperineal approach. Temporary erectile dysfunction is not negligible, with a return to baseline after 1-6 months. The incidence of infective complications is being increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, irrespective of biopsy technique. Conclusions:Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. Still, a careful appraisal of 3 patient's general health status, risk factors and likelihood of antimicrobial resistance should be done before scheduling a PB. Patient Summary:In this paper we reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, seldom represent a problem for the patient. The most troublesome complications are infections. In order to minimize this risk, a careful evaluation of patient's medical condition must be done before biopsy.4

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“…The rate is correlated with increasing antimicrobial resistance, especially to fluoroquinolones which are the current first-line recommended antibiotics. In fact, a dramatic increase in ciprofloxacinresistant strains among Escherichia coli with decreasing efficacy of ciprofloxacin prophylaxis in patients undergoing TR-PB has been reported [6]. The current rate of fluoroquinolone-resistant organisms has become a significant health problem [3].…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: fosfomycin trometamol, an attractive alternative

Cai

Gallelli²,

Cocci

et al. 2016

World J Urol

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infections (UTIs) occurring within 1 month after TR-PB. The rate of symptomatic UTIs and the rate of ADRs were considered the main outcome measures. Results In the total study population, 72/1109 (6.5 %) patients experienced symptomatic UTIs and among these 11 (0.9 % of total) had urosepsis. Out of 72, 53 (73.6 %) symptomatic UTIs were caused by fluoroquinolone-resistant strains. Out of 632, 10 (1.6 %) patients in Group 1 and 62/477 (12.9 %) patients in Group 2 had symptomatic UTIs (p < 0.001); in particular, 2/632 (0.3 %) patients in Group 1 and 9/477 (1.8 %) patients in Group 2 had urosepsis (p < 0.001). No differences were reported in terms of adverse events (0.6 vs 0.4 %; p = 0.70). A Charlson comorbidity index ≤1 and type of antimicrobial prophylaxis (FT) were found to be associated with a lower probability of symptomatic UTIs in the multivariate model. Conclusions Antibiotic prophylaxis with FT for TR-PB had a lower rate of adverse events and a lower rate of symptomatic UTIs as compared with CIP. Fosfomycin trometamol appears as an attractive alternative prophylactic regimen in prostate biopsies.

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Increasing Risk of Infectious Complications After Transrectal Ultrasound–Guided Prostate Biopsies: Time to Reassess Antimicrobial Prophylaxis?

Cited by 251 publications

References 25 publications

Clinical validation of the iXip index in avoiding unnecessary prostate biopsy: Results from a prospective multicenter study involving 426 patients

Clinical validation of the iXip index in avoiding unnecessary prostate biopsy: Results from a prospective multicenter study involving 426 patients

Complications After Systematic, Random, and Image-guided Prostate Biopsy

Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: fosfomycin trometamol, an attractive alternative

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