Strategies for prevention of ultrasound-guided prostate biopsy infections

Abstract

Prostate cancer is the most common cancer in male patients and the second leading cause of cancer-related mortality in males. To confirm the diagnosis of prostate cancer, an ultrasound-guided needle biopsy is necessary to obtain prostate tissue sufficient for histologic analysis by pathologists. Ultrasound-guided prostate needle biopsy can be accomplished via a transperineal or transrectal approach. The latter biopsy technique involves placing an ultrasound probe into the rectum, visualizing the prostate located just anterior to it, and then obtaining 12–14 biopsies. Each biopsy core requires piercing of the rectal mucosa which can inherently contribute to infection. The increasing infectious risk of prostate needle biopsy requires refinement and re-evaluation of the process in which the technique is performed. Such processes include (but are not limited to) prebiopsy risk stratification, antibiotic prophylaxis, use of rectal preparations, and equipment processing. In the subsequent review, we highlight the current available information on different strategies to reduce the risk of infection following prostate needle biopsy.

Risk factors for infectious complications following transrectal ultrasound-guided prostate biopsy

“…Currently, transrectal ultrasound-guided prostate biopsy (TRUSPB) is the gold standard for obtaining pathological specimens to diagnose prostate cancer; 3 however, complications following TRUSPB vary widely and include hematuria, hematospermia, infection, pain, rectal bleeding, urinary retention, lower urinary tract symptoms, erectile dysfunction, and mortality. 4 It has been reported that minor complications such as bleeding and pain are frequent, 5 but worryingly, infectious complications that may lead to death have increased over time.…”

Performance Validation of Selective Screening Agars for Guiding Antimicrobial Prophylaxis in Patients Undergoing Prostate Biopsy

“…Culture-guided antimicrobial prophylaxis is a promising strategy to reduce the amount of TRUSP-related infectious complications (7,12,13). In this strategy, a prebiopsy rectal swab is obtained to screen for resistant rectal GNB in the rectum in patients undergoing TRUSP.…”