The negative aftermath of prostate biopsy: prophylaxis, complications and antimicrobial stewardship: results of the global prevalence study of infections in urology 2010–2019

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Abstract

Purpose

To evaluate and report the complications, and to analyse antimicrobial stewardship aspects following prostate biopsies (P-Bx) based on the data from a 9-year global study.

Methods

The primary outcome was to compare complications after P-Bx between patients of two cohorts: 2010–2014 and 2016–2019. Primary outcomes included symptoms of lower and severe/systemic urinary tract infection (LUTIS and SUTIS, respectively), and positive urine culture. Readmission to hospital after P-Bx, need for additional antimicrobial therapy, consumption of different antimicrobial agents for prophylaxis and therapy were evaluated. Students t test and chi-square test were used for comparative analyses.

Results

Outcome data were available for 1615 men. Fluoroquinolones-based prophylaxis rate increased from 72.0% in 2010–2014 to 78.6% in 2015–2019. Overall rates of complications increased from 6 to 11.7% including an increase in symptomatic complications from 4.7 to 10.2%, mainly due to an increase in LUTIS. Rates of patients seeking additional medical help in primary care after P-Bx increased from 7.4 to 14.4%; cases requiring post P-Bx antibiotic treatment increased from 6.1 to 9.7%, most of which received fluoroquinolones. Transperineal P-Bx was significantly associated with LUTIS. Following transrectal P-Bx, 2.8% developed febrile infections and 4.0% required hospitalisation. Two men (0.12%) died after transrectal P-Bx due to sepsis.

Conclusions

The rates of complications after P-Bx tended to increase in time, as well as rates of patients seeking additional medical help in the post-P-Bx period. To reduce the risk of infectious complications and to comply with the principles of antibiotic stewardship, clinicians should switch to the transperineal biopsy route.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00345-021-03614-8.

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Most cited references 27

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Systematic Review of Complications of Prostate Biopsy

Stacy Loeb, Annelies Vellekoop, Hashim U. Ahmed … (2013)

Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer screening and treatment. To perform a systematic review of complications from prostate biopsy. A literature search was performed using PubMed and Embase, supplemented with additional references. Articles were reviewed for data on the following complications: hematuria, rectal bleeding, hematospermia, infection, pain, lower urinary tract symptoms (LUTS), urinary retention, erectile dysfunction, and mortality. After biopsy, hematuria and hematospermia are common but typically mild and self-limiting. Severe rectal bleeding is uncommon. Despite antimicrobial prophylaxis, infectious complications are increasing over time and are the most common reason for hospitalization after biopsy. Pain may occur at several stages of prostate biopsy and can be mitigated by anesthetic agents and anxiety-reduction techniques. Up to 25% of men have transient LUTS after biopsy, and <2% have frank urinary retention, with slightly higher rates reported after transperineal template biopsy. Biopsy-related mortality is rare. Preparation for biopsy should include antimicrobial prophylaxis and pain management. Prostate biopsy is frequently associated with minor bleeding and urinary symptoms that usually do not require intervention. Infectious complications can be serious, requiring prompt management and continued work into preventative strategies. Published by Elsevier B.V.

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

Marco Borghesi, Hashim Ahmed, Robert Nam … (2017)

Prostate biopsy (PB) represents the gold standard method to confirm the presence of cancer. In addition to traditional random or systematic approaches, a magnetic resonance imaging (MRI)-guided technique has been introduced recently.

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Best practice policy statement on urologic surgery antimicrobial prophylaxis.

J. Stuart Wolf Jr., Carol Bennett, Roger R. Dmochowski … (2008)

Antimicrobial prophylaxis is the periprocedural systemic administration of an antimicrobial agent intended to reduce the risk of postprocedural local and systemic infections. The AUA convened a BPP Panel to formulate recommendations on the use of antimicrobial prophylaxis during urologic surgery. Recommendations are based on a review of the literature and the Panel members' expert opinions. The potential benefit of antimicrobial prophylaxis is determined by patient factors, procedure factors, and the potential morbidity of infection. Antimicrobial prophylaxis is recommended only when the potential benefit outweighs the risks and anticipated costs (including expense of agent and administration, risk of allergic reactions or other adverse effects, and induction of bacterial resistance). The prophylactic agent should be effective against organisms characteristic of the operative site. Cost, convenience, and safety of the agent also should be considered. The duration of antimicrobial prophylaxis should extend throughout the period when bacterial invasion is facilitated and/or likely to establish an infection. Prophylaxis should begin within 60 minutes of the surgical incision (120 minutes for intravenous fluoroquinolines and vancomycin) and generally should be discontinued within 24 hours. The AHA no longer recommends antimicrobial prophylaxis for genitourinary surgery solely to prevent infectious endocarditis. Justifications and recommendations for specific antimicrobial prophylactic regimens for specific categories of urologic procedures are provided. The recommendations provided in this document, including specific indications and agents enumerated in the Tables, can assist urologists in the appropriate use of periprocedural antimicrobial prophylaxis.

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Author and article information

Contributors

Florian M. Wagenlehner:

ORCID: http://orcid.org/0000-0002-2909-0797

florian.wagenlehner@chiru.med.uni-giessen.de

Journal

Journal ID (nlm-ta): World J Urol

Journal ID (iso-abbrev): World J Urol

Title: World Journal of Urology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0724-4983

ISSN (Electronic): 1433-8726

Publication date (Electronic): 22 February 2021

Publication date PMC-release: 22 February 2021

Publication date (Print): 2021

Volume: 39

Issue: 9

Pages: 3423-3432

Affiliations

[1 ]GRID grid.8664.c, ISNI 0000 0001 2165 8627, Clinic for Urology, Pediatric Urology and Andrology, , Justus-Liebig-University Giessen, ; Giessen, Germany

[2 ]GRID grid.415176.0, ISNI 0000 0004 1763 6494, Department of Urology, , Santa Chiara Hospital, ; Trento, Italy

[3 ]GRID grid.5395.a, ISNI 0000 0004 1757 3729, Department of Urology, , University of Pisa, ; Pisa, Italy

[4 ]Department of Urology, Alta Uro AG, Basel, Switzerland

[5 ]GRID grid.411777.3, ISNI 0000 0004 1765 1563, Urologie, , CHU Bretonneau, ; Tours, France

[6 ]GRID grid.12366.30, ISNI 0000 0001 2182 6141, Université François Rabelais de Tours, PRES Centre Val de Loire, ; Tours, France

[7 ]Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary

[8 ]Urogenital Department, Novosibirsk Research TB Institute, Koves Str 1. 1204, Budapest, 630040 Novosibirsk, Russian Federation

[9 ]GRID grid.144756.5, ISNI 0000 0001 1945 5329, Department of Urology, , Hospital Universitario 12 de Octubre, ; Madrid, Spain

[10 ]GRID grid.6936.a, ISNI 0000000123222966, School of Medicine, , Technical University of Munich, ; Munich, Germany

[11 ]GRID grid.415738.c, ISNI 0000 0000 9216 2496, Department of Urinary Tract Infections and Clinical Pharmacology N.A, , Lopatkin Scientific Research Institute of Urology and Interventional Radiology, Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, ; Moscow, Russian Federation

[12 ]GRID grid.439749.4, ISNI 0000 0004 0612 2754, Department of Urology, , University College London Hospitals, ; London, UK

[13 ]GRID grid.5510.1, ISNI 0000 0004 1936 8921, Department of Urology, , Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, ; Oslo, Norway

[14 ]GRID grid.7048.b, ISNI 0000 0001 1956 2722, Institute of Clinical Medicine, , University of Aarhus, ; Aarhus, Denmark

Author information

Jakhongir F. Alidjanov http://orcid.org/0000-0003-2531-4877

Tommaso Cai http://orcid.org/0000-0002-7234-3526

Riccardo Bartoletti http://orcid.org/0000-0002-0021-0302

Gernot Bonkat http://orcid.org/0000-0002-7298-6468

Franck Bruyère http://orcid.org/0000-0002-9281-9421

Béla Köves http://orcid.org/0000-0001-6886-0750

Ekaterina Kulchavenya http://orcid.org/0000-0001-7965-2711

José Medina-Polo http://orcid.org/0000-0003-3626-8669

Kurt Naber http://orcid.org/0000-0003-1304-5403

Tamara Perepanova http://orcid.org/0000-0002-2877-0029

Adrian Pilatz http://orcid.org/0000-0001-8072-1841

Zafer Tandogdu http://orcid.org/0000-0002-5309-3656

Truls E. Bjerklund Johansen http://orcid.org/0000-0003-3490-6460

Florian M. Wagenlehner http://orcid.org/0000-0002-2909-0797

Article

Publisher ID: 3614

DOI: 10.1007/s00345-021-03614-8

PMC ID: 8510929

PubMed ID: 33615393

SO-VID: 691782a0-b30c-45e1-be94-5d2755c74137

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 29 October 2020

Date accepted : 25 January 2021

Custom metadata

ScienceOpen disciplines: Urology

Keywords: prostate biopsy,antibiotic resistance,prostate cancer,antibiotics,fluoroquinolones

Data availability:

ScienceOpen disciplines: Urology

Keywords: prostate biopsy, antibiotic resistance, prostate cancer, antibiotics, fluoroquinolones

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The negative aftermath of prostate biopsy: prophylaxis, complications and antimicrobial stewardship: results of the global prevalence study of infections in urology 2010–2019

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Abstract

Purpose

Methods

Results

Conclusions

Supplementary Information

Related collections

Microbiology Independent Research Journal (MIR Journal)

Most cited references 27

Systematic Review of Complications of Prostate Biopsy

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

Best practice policy statement on urologic surgery antimicrobial prophylaxis.

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Contributors

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Cited by 8

Most referenced authors 273