Rectal Cultures Before Transrectal Ultrasound-guided Prostate Biopsy Reduce Post-prostatic Biopsy Infection Rates

Duplessis, Christopher; Bavaro, Mary; Simons, Mark P.; Marguet, Charles G.; Santomauro, Michael; Auge, Brian K.; Collard, D; Fierer, Joshua; L’Esperance, James O.

doi:10.1016/j.urology.2011.09.057

Cited by 141 publications

(127 citation statements)

References 25 publications

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“…1,4,5,8 About 11% to 22% of males undergoing TRUS-PB harbour FQ resistant bacteria within their rectum. [13][14][15][16][17] Regional reports from our site demonstrate a rise in ciprofloxacin resistance in community strains of E. coli from 7% to 11% over the past 5 years. 18,19 In Latin America and India, the rates are as high as 75%.…”

Section: Introductionmentioning

confidence: 83%

“…Adjunctive measures with pre-biopsy rectal swabs, enemas, and povidone iodine rectal cleanse have shown conflicting and clinically insignificant results. 14,27,29 Currently, there are no concrete mitigating strategies to reduce the risk of post-TRUS-PB associated infections. Furthermore, there are no clinical practice guidelines on the management of post-biopsy infectious complications.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

Rudzinski

Kawakami²

2014

CUAJ

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Introduction:We have seen an increased risk of infectious complications following transrectal ultrasound-guided prostate biopsy (TRUS-PB). Fluoroquinolone (FQ) antibiotics are common for prophylaxis prior to TRUS-PB. We evaluate whether increasing FQ resistance correlates with increased incidence of post-biopsy infectious complications at our institution. Methods: We conducted a retrospective chart and electronic health record review on 927 patients who underwent TRUS-PB between January and July of 2012 in Calgary, Alberta, Canada. We prospectively collected the following variables: age, pre-biopsy prostatespecific antigen, and date of biopsy. We documented presentation to an emergency department within 30 days of TRUS-PB for infectious and non-infectious complications. Results: Of the 927 patients, 58 patients (6.3%) were admitted to the emergency department due to post-TRUS-PB complications within 30 days post-biopsy. The most common infectious complications were sepsis in 21 patients (2.2%), followed by urinary tract infection (UTI) in 9 (0.9%), and prostatitis in 4 (0.4%). We found that 83% of the septic episodes and 66.6% of the UTIs were attributed to ciprofloxacin resistant Escherichia coli (E. coli). The incidence of non-infectious complications was as follows: urinary retention in 12 (1.2%), hematuria in 9 (0.9%), and rectal bleeding in 8 (0.8%). Conclusion: Our results suggest an increased incidence of infectious complications caused by FQ resistant organisms following TRUS-PB. This finding could be attributed to increasing community resistance to ciprofloxacin. The current antimicrobial prophylactic regimen needs to be re-evaluated, and a novel approach may need to be considered.

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Section: Introductionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

Rudzinski

Kawakami²

2014

CUAJ

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“…A growing body of nonrandomized studies support rectal swab-targeted prophylaxis for transrectal PB. Duplessis et al showed no infectious complications in men receiving targeted prophylaxis, in contrast with those using standard ciprofloxacin 80 . Similarly, Cook and collaborators reported a significant drop in infections after the introduction of rectal swab-targeted prophylaxis in routine clinical practice compared to a retrospective cohort receiving standard fluoroquinolones(0.41% vs.…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

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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“…Two recent studies investigated the use of rectal cultures to provide a targeted approach to prophylaxis (10,11). Both studies showed a 0% infection rate after implementation of rectal cultures to guide prophylactic antibiotic therapy and also a cost reduction related to the prevention of hospitalization due to infectious complications.…”

mentioning

confidence: 99%

“…Unfortunately, neither of these studies was a true randomized study nor sufficiently powered to detect a substantial difference. In addition, previous studies investigating ciprofloxacin resistance in fecal flora used different methods of collection, isolation techniques, and timing relative to the prostate biopsy (7)(8)(9)(10)(11)(12).…”

mentioning

confidence: 99%

Comparison of Broth Enhancement to Direct Plating for Screening of Rectal Cultures for Ciprofloxacin-Resistant Escherichia coli

2013

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A transrectal prostate biopsy is the most common procedure used to establish the diagnosis of prostate cancer. Prior to biopsy, patients are commonly given ciprofloxacin for prophylaxis. However, a complication of the procedure is infection with ciprofloxacin-resistant organisms, in particular resistant Escherichia coli. In order to identify patients carrying ciprofloxacin-resistant E. coli, so as to tailor their antibiotic prophylaxis, rectal swabs are screened using selective broth and/or solid medium. In our evaluation, we compared broth enrichment and direct plating techniques by using brain heart infusion broth and MacConkey agar containing 1 g/ml or 10 g/ml of ciprofloxacin. Of the 100 patients included in the study, 20 were colonized with ciprofloxacin-resistant organisms, 19 of which were E. coli. There was no significant difference (P > 0.1) between the culture methods or the ciprofloxacin concentrations in the medium when identifying patients with ciprofloxacin-resistant E. coli; however, broth enrichment using 1 g/ml ciprofloxacin was the most sensitive at 100%, but it was the least specific. Direct plating of rectal swabs onto MacConkey agar containing 10 g/ml of ciprofloxacin was 100% specific and missed only 1 positive specimen, with a sensitivity of 94.7%; this method was the most cost-effective. Therefore, direct plating of rectal swabs onto selective medium proved to be a sensitive and cost-effective approach in identifying patients colonized with ciprofloxacin-resistant E. coli.

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Rectal Cultures Before Transrectal Ultrasound-guided Prostate Biopsy Reduce Post-prostatic Biopsy Infection Rates

Cited by 141 publications

References 25 publications

Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

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

Comparison of Broth Enhancement to Direct Plating for Screening of Rectal Cultures for Ciprofloxacin-Resistant Escherichia coli

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