Elsevier

European Urology

Volume 63, Issue 3, March 2013, Pages 521-527
European Urology

Platinum Priority – Infections
Editorial by Riccardo Bartoletti and Tommaso Cai on pp. 528–529 of this issue
Infective Complications After Prostate Biopsy: Outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, A Prospective Multinational Multicentre Prostate Biopsy Study

https://doi.org/10.1016/j.eururo.2012.06.003Get rights and content

Abstract

Background

Infection is a serious adverse effect of prostate biopsy (P-Bx), and recent reports suggest an increasing incidence.

Objective

The aim of this multinational multicentre study was to evaluate prospectively the incidence of infective complications after P-Bx and identify risk factors.

Design, setting, and participants

The study was performed as an adjunct to the Global Prevalence Study of Infections in Urology (GPIU) during 2010 and 2011. Men undergoing P-Bx in participating centres during the 2-wk period commencing on the GPIU study census day were eligible.

Outcome measurements and statistical analysis

Baseline data were collected and men were questioned regarding infective complications at 2 wk following their biopsy. The Fisher exact test, Student t test, Mann-Whitney U test, and multivariate regression analysis were used for data analysis.

Results and limitations

A total of 702 men from 84 GPIU participating centres worldwide were included. Antibiotic prophylaxis was administered prior to biopsy in 98.2% of men predominantly using a fluoroquinolone (92.5%). Outcome data were available for 521 men (74%). Symptomatic urinary tract infection (UTI) was seen in 27 men (5.2%), which was febrile in 18 (3.5%) and required hospitalisation in 16 (3.1%). Multivariate analysis did not identify any patient subgroups at a significantly higher risk of infection after P-Bx. Causative organisms were isolated in 10 cases (37%) with 6 resistant to fluoroquinolones. The small sample size per participating site and in compared with other studies may have limited the conclusions from our study.

Conclusions

Infective complications after transrectal P-Bx are important because of the associated patient morbidity. Despite antibiotic prophylaxis, 5% of men will experience an infective complication, but none of the possible factors we examined appeared to increase this risk. Our study confirms a high incidence of fluoroquinolone resistance in causative bacteria.

Introduction

Prostate biopsy (P-Bx) is currently an essential procedure for prostate cancer diagnosis [1] and a frequently performed procedure in urology with an estimated 1 million cases each year in Europe. Following the introduction of transrectal ultrasound-guided P-Bx [2], this procedure has been widely accepted and optimised in recent years, continuously following the transrectal route [1]. A systematic review on randomised controlled studies (RCTs) on antibiotic prophylaxis in transrectal P-Bx showed a significant reduction in the risk of bacteriuria compared with placebo [3]. Reductions in symptomatic urinary tract infections (UTIs) and bacteremia were also seen but did not reach statistical significance [3]. Clinical guidelines therefore recommend antibiotic prophylaxis, typically with a oral fluoroquinolone, prior to transrectal P-Bx [4], [5]. Several reports have recently suggested an increased rate of infective complications following transrectal P-Bx in both North America [6], [7] and Europe [8]. The reasons for this increase and the factors associated with a higher susceptibility to infection remain largely unknown.

The aim of this international study was to evaluate the worldwide prevalence of infective complications after P-Bx and determine whether putative risk factors are associated with a higher rate of infection.

Section snippets

Study design

This prospective observational multinational multicentre epidemiologic study was performed as a part of the annual worldwide Global Prevalence Study on Infections in Urology (GPIU) in 2010 and 2011. The GPIU study has been performed annually since 2003 and consists of a 1-d prevalence census of infections experienced by patients hospitalised in urology units. It is organised by the board of the European Section for Infections in Urology (ESIU) [9], [10]. The study was endorsed and sponsored by

Results

A total of 84 centres in Africa (n = 2), Asia (n = 11), Europe (n = 67), and South-America (n = 4) participated in the GPIU prostate biopsy study (see appendix). The centres included a median of 4 evaluable patients for each year of participation (range: 1–25; standard deviation [SD]: ±6.7). A total of 702 men were included across the two study years (2010, n = 385; 2011, n = 317). Median patient age was 66 yr (range: 40–90; SD: ±8.0). Table 1 shows the biopsy performance parameters.

Outcome at 2 wk was

Discussion

Millions of men undergo P-Bx throughout the world each year as part of the accepted diagnostic pathway for prostate cancer [6]. Recently retrospective studies from Canada [7] and the United States [6] and one prospectively performed study from Europe [8] reported an apparent increase in the incidence of infective complications after transrectal P-Bx. In this study we found that just over 5% of men experienced symptomatic UTI after P-Bx, which resulted in serious morbidity in about 70% of cases

Conclusions

In this prospective multinational study on infective complications after P-Bx, a significant rate of infective complications after P-Bx was observed to be present worldwide. Our study supports the findings of others in suggesting that the presence of faecal fluoroquinolone-resistant bacteria is the most important risk factor. If this is the case, strategies to identify fluoroquinolone-resistant bacteria should be sought so as to decrease infective complications after P-Bx. This important and

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