Prosbiotate: A Multicenter, Prospective Analysis of Infectious Complications after Prostate Biopsy

Bruyère, F.; Malavaud, S.; Bertrand, P.; Decock, Aliette; Cariou, G.; Doublet, Jean‐Dominique; Bernard, Louis; Bugel, H.; Conquy, S; Sotto, Albert; Boiteux, Jean‐Paul; Pogu, B.; Rébillard, Xavier; Mongiat-Artus, Pierre; Coloby, P.

doi:10.1016/j.juro.2014.07.086

Cited by 70 publications

(55 citation statements)

References 19 publications

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“…Asymptomatic bacteriuria, febrile urinary tract infections (UTI), acute bacterial prostatitis, orchitis, epididymitis, and urinary sepsis represent the broad spectrum of possible infectious complications 1,45,46 . Accordingly, antibiotic prophylaxis is recommended as the standard of care 1,47,48 .…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

“…Fluoroquinolone resistant organisms have been identified in 10-30% of patients undergoing rectal swab culture before PB 47,[49][50][51][52] , although rates of clinical infectious complications are lower at approximately 1-17.5% 7,45,46,48,[53][54][55][56][57] . Most infections are self-limiting and can be managed in the outpatient setting 7,45 .…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

“…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 . Whether a repeated biopsy protocol, including those done in active surveillance (AS), could increase the risk of infection is unclear.…”

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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Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

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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“…This imprecision is due to the fact that it remains impossible to visualize the exact localization of PB by using a 2D US probe, so that the biopsies often do not correspond to the prostatic region that was initially targeted. Therefore, repeat PBs are often necessary to disclose PC, associated with the risk of acute prostatitis and sepsis amounting up to 5% [4] and 3%, respectively [5] .…”

Section: Introductionmentioning

confidence: 99%

Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques

Klein¹,

Górski²,

Benamran³

et al. 2016

Urol Int

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Introduction: The study aimed to evaluate 3 different modalities of transrectal ultrasound (TRUS)-guided prostate biopsies (PBs; 2D-, 3D- and targeted 3D-TRUS with fusion to MRI - T3D). Primary end point was the detection rate of prostate cancer (PC). Secondary end point was the detection rate of insignificant PC according to the Epstein criteria. Patients and Methods: Inclusion of 284 subsequent patients who underwent 2D-, 3D- or T3D PB from 2011 to 2015. All patients having PB for initial PC detection with a serum prostate-specific antigen value ≤20 ng/ml were included. Patients with T4 and/or clinical and/or radiological metastatic disease, so as these under active surveillance were excluded. Results: Patients with T3D PB had a significantly higher detection rate of PC (58 vs. 19% for 2D and 38% for 3D biopsies; p = 0.001), with no difference in Gleason score distribution (p = 0.644), as well as detection rate of low-risk cancers (p = 0.914). Main predictive factor for positive biopsies was the technique used, with respectively a 3- and 8-fold higher detection rate in the 3D- and T3D group. For T3D-PB, there was a significant correlation between radiological cancer suspicion (Prostate Imaging Reporting and Data System Score) and cancer detection rate (p = 0.02). Conclusions: T3D PB should be preferred over 2D PB and 3D PB in patients with suspected PC as it improves the cancer detection rate.

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“…Similarly, the European Association of Urology guidelines recommend single-dose prophylaxis for low-risk patients and prolonged courses of prophylaxis only in high-risk patients [27]. However, according to a recent prospective multicenter study, in cases of guideline noncompliance, quinolones were administered for durations not in accordance with the recommended 1-day treatment by 75% of investigators [28]. Asian men are at risk for infectious complications because of possible high exposure to antibiotics as a medicine or in meat [15,26].…”

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confidence: 99%

Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study

Hwang

Jung

et al. 2016

Urogenit Tract Infect

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Purpose: Recent studies have highlighted an increasing trend of infectious complications due to fluoroquinolone-resistant organisms among men undergoing transrectal prostate biopsy. This study evaluated the current incidence of infective complications after trans-rectal prostate biopsy for identification of risk factors in Korean men who received fluoroquinolone prophylaxis. Materials and Methods: A prospective, multicenter study was conducted in Korea from January to December 2015. Prostate biopsies performed with fluoroquinolone prophylaxis during 3 months in each center were included. A pre-biopsy questionnaire was used for identification of patient characteristics. Clinical variables including underlying disease, antibiotic prophylaxis, enema, povidoneiodine cleansing of the rectum, and infectious complications were evaluated. The primary outcome was the post-biopsy infection rate after fluoroquinolone prophylaxis. Univariable and multivariable analyses were used for identification of risk factors for infectious complications. Results: The study included 827 patients, of whom 93 patients (11.2%) reported receiving antibiotics in the previous 6 months and 2.5% had a history of prostatitis. The infectious complication rate was 2.2%. Post-biopsy sepsis was reported in 2 patients (0.2%). In multivariable analysis predictors of post-biopsy sepsis included person performing biopsy (adjusted odds ratio [OR], 4.05; 95% confidence interval [CI], 1.31-12.5; p=0.015) and operation history within 6 months (adjusted OR, 5.65; 95% CI, 1.74-18.2; p=0.004). Conclusions:The post-prostate biopsy infectious complication rate in this study was 2.2%. Person performing biopsy (non-urologists) and recent operation history were independent risk factors for infectious complications after trans-rectal prostate biopsy. . Fluoroquinolones (FQs) are particularly useful in this setting owing to their broad spectrum of activity against intestinal flora as well as their high prostatic tissue levels after oral administration [2,3]. KeywordsDespite antibiotic prophylaxis, several recent studies have reported an increased rate of infective complications following transrectal prostate biopsy in both North America and Europe [4][5][6][7][8]. A recent review of the literature found that up to 6.3% of patients required hospitalization due to post-biopsy complications [4]. This has led to increased use of multiple broad-spectrum antibiotics for prophylaxis; however, this practice may accelerate the development of resistant bacteria [9,10]. The most common pathogen implicated in post-transrectal prostate biopsy sepsis is Escherichia coli, accounting for approximately 75-90% of infectious complications. Antimicrobial-resistant E. coli has been increasingly reported in post-biopsy sepsis over the past decade [8]. The link between prior FQ exposure, colonization with fluoroquinolone-resistant (FQ-R) E. coli, and subsequent post-biopsy infection with FQ-R E. coli was also recently demonstrated [11]. The risk of post-biopsy infection is increased by 7-f...

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Prosbiotate: A Multicenter, Prospective Analysis of Infectious Complications after Prostate Biopsy

Cited by 70 publications

References 19 publications

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

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

Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques

Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study

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