Prostate biopsy techniques and pre-biopsy prophylactic measures: variation in current practice patterns in the Netherlands

Abstract

Background: The clinical landscape of prostate biopsy (PB) is evolving with changes in procedures and techniques. Moreover, antibiotic resistance is increasing and influences the efficacy of pre-biopsy prophylactic regimens. Therefore, increasing antibiotic resistance may impact on clinical care, which probably results in differences between hospitals. The objective of our study is to determine the (variability in) current practices of PB in the Netherlands and to gain insight into Dutch urologists' perceptions of fluoroquinolone resistance and biopsy related infections. Methods: An online questionnaire was prepared using SurveyMonkey® platform and distributed to all 420 members of the Dutch Association of Urology, who work in 81 Dutch hospitals. Information about PB techniques and periprocedural antimicrobial prophylaxis was collected. Urologists' perceptions regarding pre-biopsy antibiotic prophylaxis in an era of antibiotic resistance was assessed. Descriptive statistical analysis was performed. Results: One hundred sixty-one responses (38.3%) were analyzed representing 65 (80.3%) of all Dutch hospitals performing PB. Transrectal ultrasound guided prostate biopsy (TRUSPB) was performed in 64 (98.5%) hospitals. 43.1% of the hospitals (also) used other image-guided biopsy techniques. Twenty-three different empirical prophylactic regimens were reported among the hospitals. Ciprofloxacin was most commonly prescribed (84.4%). The duration ranged from one pre-biopsy dose (59.4%) to 5 days extended prophylaxis. 25.2% of the urologists experienced ciprofloxacin resistance as a current problem in the prevention of biopsy related infections and 73.6% as a future problem. Conclusions: There is a wide variation in practice patterns among Dutch urologists. TRUSPB is the most commonly used biopsy technique, but other image-guided biopsy techniques are increasingly used. Antimicrobial prophylaxis is not standardized and prolonged prophylaxis is common. The wide variation in practice patterns and lack of standardization underlines the need for evidence-based recommendations to guide urologists in choosing appropriate antimicrobial prophylaxis for PB in the context of increasing antibiotic resistance.

Contemporary practice of prostate biopsy in Nigeria: Differences in technique and prophylactic measures among urologist

“…[18] Random systematic TRUS prostate biopsy of the prostate is presently the preferred method. [19] The European Association of Urology [20] in recent times recommended performing multi-parametric magnetic resonance imaging (mpMRI) before prostate biopsy in biopsy-naïve patients.…”

“…While these guidelines generally recommend antimicrobial prophylaxis in trans-rectal prostate biopsy, the choice of regimen, duration, and the starting moment is ambiguous. [18][19][20] Sabbagh et al [22] suggested that a single-dose regimen of the combination of fluoroquinolones and nitroimidazoles is as effective as 3 days of treatment of same combination. According to the current guidelines, the length of antimicrobial prophylaxis should be limited to about 24 h. [19,20] In this study, only about 7% of the Urologists give antibiotics for only 24 h with most giving antimicrobial prophylaxis for 3-7 days.…”

“…[18][19][20] Sabbagh et al [22] suggested that a single-dose regimen of the combination of fluoroquinolones and nitroimidazoles is as effective as 3 days of treatment of same combination. According to the current guidelines, the length of antimicrobial prophylaxis should be limited to about 24 h. [19,20] In this study, only about 7% of the Urologists give antibiotics for only 24 h with most giving antimicrobial prophylaxis for 3-7 days. The reason for this discrepancy could be due to lack of standardized guidelines for prophylaxis in TNBP.…”

Comparison of Fluoroquinolones and Other Antibiotic Prophylaxis Regimens for Preventing Complications in Patients Undergoing Transrectal Prostate Biopsy

“…To minimize severe complications, antibiotic prophylaxis is recommended [11]. Antimicrobial prophylaxis is not standardized, and prolonged prophylaxis is common [12]. The guidelines recommend other hygienic measures, such as rectal cleansing with povidone-iodine before the procedure.…”

Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience

“…1 Antibiotic prophylaxis for TRPB is the standard of care, although there is variation in the type, timing and duration of antibiotics, and whether urine or rectal microscopy, culture and sensitivities are obtained in advance. 4 Fluoroquinolone antibiotics which are commonly used as prophylaxis have a non-trivial side-effect profile, 5 and increasing rates of fluoroquinolone resistance pose a growing problem. 1,6 In theory, transperineal (TP)PB offers a considerable reduction in the rate of infection-related complications by avoiding inoculation of vascular prostate tissue with faecal bacteria.…”