Prostate Biopsy-related Infection: A Systematic Review of Risk Factors, Prevention Strategies, and Management Approaches

Roberts, Matthew J.; Bennett, Harrison Y.; Harris, Patrick N A; Holmes, Michael; Grummet, Jeremy; Naber, Kurt G.; Wagenlehner, Florian M. E.

doi:10.1016/j.urology.2016.12.011

Cited by 111 publications

(99 citation statements)

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“…Fewer strategies that are aimed at reducing the bacterial load in the passage of the biopsy needle through the bowel are reported compared with antimicrobial‐related studies. However, a meta‐analysis of seven controlled trials ( n = 2049) of rectal disinfection using povidone‐iodine rectal preparation before biopsy have shown significant reductions in fever, bacteriuria and bacteremia regardless of the prophylaxis used . Targeted antibiotic coverage based on rectal cultures has been pursued as an alternative strategy and complies with antibiotic stewardship.…”

Section: Discussionmentioning

confidence: 99%

Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study

et al. 2018

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Objectives To investigate whether switching ciprofloxacin to fosfomycin in the case of fluoroquinolone‐resistant rectal bacteria influences the incidence of infectious complications after transrectal prostate biopsy. Methods From December 2015 until December 2017, patients undergoing prostate biopsy were randomly assigned to a control group or an intervention group in a prospective, open‐label fashion at three different centers. The presence of fluoroquinolone‐resistant organisms was detected by rectal swabs. Patients in the control group received ciprofloxacin. Patients in the intervention group received fosfomycin instead of ciprofloxacin in the case of fluoroquinolone‐resistant bacteria on rectal swab culture. The primary end‐point was the difference in occurrence of major (febrile) and minor (afebrile) infections between both groups. Results A total of 102 patients were randomized to the control group, and 102 patients to the intervention group. In the control group, nine complications occurred, of which five were major febrile complications. In the intervention group, six complications occurred, of which four were major febrile complications. The total number of complications (major and minor) did not differ between both groups (P = 0.59). A subgroup analysis of patients with fluoroquinolone‐resistant bacteria on rectal swab showed five complications in the control group and one complication in the intervention group (P = 0.09). Conclusions This represents the first prospective randomized study using rectal cultures for targeted antibiotic prophylaxis. Study findings show promising results for use of fosfomycin in patients with fluoroquinolone resistance.

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Section: Discussionmentioning

confidence: 99%

Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study

et al. 2018

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“…Additionally, TRUSBP can lead to complications such as hematuria, hematospermia, rectal bleeding, prostatitis, epididymitis, sepsis, and urinary retention 24, 25, 26. Therefore, each TRUSBP constitutes a risk in terms of complications.…”

Section: Discussionmentioning

confidence: 99%

Is Prostate Biopsy Recommended in Turkish Men with a Prostate-Specific Antigen Level between 2.5 and 4 ng/mL?

Koç¹,

Türk

Karabıçak³

et al. 2017

Current Therapeutic Research

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BackgroundProstate cancer is the most common solid tumor. The incidence of prostate cancer shows regional and racial differences. The ideal PSA threshold for prostate biopsy is still being debated.ObjectiveWe aimed to investigate cancer detection rates in Turkish men who underwent transrectal ultrasound-guided prostate biopsy (TRUSPB) who had prostate-specific antigen (PSA) levels in the range of 2.5 to 4.0 ng/mL and compare them with the rates of cancer in patients with PSA levels in the range of 4.0 to 10.0 ng/mL.MethodsAll Turkish men who underwent TRUSPB in our clinic between January 2012 and May 2014 were included; that is, 101 patients (Group 1) with PSA level in the range of 2.5 to 4.0 ng/mL and 522 patients (Group 2) with PSA level in the range of 4.0 to 10.0 ng/mL. Mean PSA level, age, prostate volume, and cancer detection rates were evaluated.ResultsThe mean age was 60.5 and 64 years in Group 1 and Group 2, respectively (P = 0.06). The mean PSA level was determined as 3.1 and 6.8 ng/mL in Group 1 and Group 2, respectively (P = 0.03). The cancer detection rate was 12.7% in Group 1 (n = 13) and 30.8% in Group 2 (n = 161), which revealed a statistically significant difference between the 2 groups (P = 0.001). In Group 1, 9 of 13 patients (69%) had Gleason score of 6, 3 (23%) had Gleason score of 7, and 1 (8%) had a Gleason score of 8.ConclusionsThe cancer detection rate is lower in Turkish men with PSA level in the range of 2.5 to 4.0 ng/mL when compared with men with PSA level in the range of 4.0 to 10.0 ng/mL. Furthermore, most patients in whom cancer was detected who have a PSA level in the range of 2.5 to 4.0 ng/mL are low risk. Therefore, the benefit of TRUSBP in Turkish men with PSA level between 2.5 and 4 ng/mL is low.

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confidence: 99%

“…Transrectal ultrasound‐guided prostate biopsy (TRUSPB) is the most common method of prostate cancer detection . Concern regarding TRUSPB‐related infections despite antimicrobial prophylaxis, chiefly due to the development of fluoroquinolone (FQ) resistance, has prompted the development of adjunct prophylaxis methods and biopsy approaches . Fosfomycin trometamol (FT) has long been used in the USA and Europe with broad‐spectrum bactericidal coverage and adequate prostatic soft tissue concentrations, and has been shown to reduce TRUSPB‐related infections compared with FQ‐based prophylaxis …”

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confidence: 99%

“…More evidence continues to accumulate that FT prophylaxis can potentially reduce cost, morbidity and mortality associated with TRUSPB infectious complications. These are pertinent to contemporary practice in the face of a recent Federal Drug Administration warning of disabling and potentially permanent serious side‐effects of FQs . Use of FT broadly or as part of targeted antimicrobial prophylaxis regimes with rectal swabs might improve outcomes while more accurate biomarkers and imaging are developed or until wider adoption of transperineal approaches.…”

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Editorial Comment from Dr Macdonald and Dr Roberts to Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study

Macdonald

Roberts

2019

Int J of Urology

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Prostate Biopsy-related Infection: A Systematic Review of Risk Factors, Prevention Strategies, and Management Approaches

Cited by 111 publications

References 112 publications

Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study

Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study

Is Prostate Biopsy Recommended in Turkish Men with a Prostate-Specific Antigen Level between 2.5 and 4 ng/mL?

Editorial Comment from Dr Macdonald and Dr Roberts to Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study

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