Prevention and management of infectious complications in prostate biopsy: A review

Abstract

Prostate biopsies are common procedures for urologists, performed in order to detect and diagnose prostate cancer. Procedures continue to evolve, for instance, recently there has been an increase in the use of the transperineal approach, and the emergence of antibiotic-resistant bacteria has become a challenge. This review examines the recent prostate biopsy literature as well as the guidelines of three urological associations. We review the recent literature, including our own recent studies, and the Japanese Urological Association, European Association of Urology and American Urological Association guidelines, and summarize the current recommendations regarding the prevention of infectious complications that can occur after prostate biopsy, including the use of antimicrobial agents, and the management and treatment of such complications. Current recommendations include single-dose or 1-day use of oral quinolones for infection control, along with consideration of high-risk patients with diabetes, steroid use, large prostates, or high residual urine volume for instance. Targeted therapies based on the results of rectal swabs carried out prior to transrectal prostate biopsy, which can provide better inhibitory data with regard to post-prostate biopsy infectious complications, can also be considered. In conclusion, oral quinolones for low-risk patients and targeted therapies for high-risk patients are recommended when using a transrectal approach to prostate biopsy, and oral quinolones are recommended when using a transperineal approach. Further randomized controlled trials are necessary to draw more definitive conclusions.

Should we review our prophylaxis approach for increased antibiotic resistance in transrectal prostate biopsy?

“…ESBL-producing Gramnegative bacteria was determined in 40% of infections in blood and 38.5% of urinary system infections in the post-biopsy period in this study. Serious infections caused by ESBL-positive bacteria can result in treatment failure, increased morbidity, mortality, and cost [1][2][3]. The use of FQ or third-generation cephalosporins induces ESBL production in Gramnegative bacteria [15].…”

“…Transrectal ultrasound-guided prostate biopsy (TRUSBx) is associated with a severe infection risk [1,2]. Although antibiotic prophylaxis usually with fluoroquinolones is routinely used, the infection rate after TRUSBx is increasing due to antibiotic resistance [1,3].…”

Safety profile of robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate

“…TR offers practicability in the in-office setup due to feasibility under local anesthesia reflected by the majority of PB x being performed via the TR approach in the US (93.1 – 99.2%) ( 4 ). However, punction of the prostate through the rectum ampulla is associated with a significant risk for infectious complications ( 5 ). The incidence for infectious complications after TR-PB x ranges between 5 and 7% with a hospitalization rate of about 2% ( 2 , 3 ).…”