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Abstract
With the widespread popularity of prostate specific antigen testing, transrectal ultrasound (TRUS)-guided prostate biopsy has become a common urological procedure. The most common risks and complications associated with TRUS-guided biopsy include hematuria, hematospermia, and hematochezia. In addition, some patients develop urinary tract infections, acute bacterial prostatitis, bacteremia, and, eventually, urosepsis. Although it is commonly accepted that use of a prophylactic antimicrobial agent will lower the incidence of post biopsy infection, there is little consensus regarding the most appropriate antimicrobial regimens. Fluoroquinolone (FQ) was the best analyzed class, with higher numbers of studies and patients. According to recent data, occurrence of infectious complications after prostate biopsy has increased in recent years. Several recent studies have highlighted an increasing trend of infectious complications due to FQ resistant organisms among men undergoing TRUS guided prostate biopsy. TRUS guided prostate biopsy can result in significant morbidity, which is occurring at an increasing rate due to the increasing prevalence of FQ resistant Escherichia coli in rectal flora. Risk factors for harboring FQ resistant E. coli should be considered before prostate biopsy, and rectal swab screening cultures may provide useful evidence for selection of appropriate antimicrobials for prophylaxis and treatment of prostate biopsy-associated infections. The estimate of the incidence of sepsis following TRUS-guided prostate biopsy is low; however, the initial treatment of patients with prophylaxis failure and identification of antibiotic-resistant bacterial strains might be the most important means for prevention of urosepsis.
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Table 1.
A surgical wound classes and risk of wound infection22
Table 2.
Antibiotic prophylaxis for transrectal prostate biopsy according to systemic review
| Analysis | Summary |
|---|---|
| - No prophylaxis vs. antibiotic prophylaxis | Antibiotic prophylaxis is effective. |
| - Quinolones vs. other classes of antibiotics (sulfonamides, piperacillin, tazobactam and ceftriaxone) | No difference |
| - Oral vs. systemica antibiotics | No difference |
| - Antibiotic vs. antibiotic+ enema | Reduced bacteremia by antibiotic+ enema |
| Others: no difference | |
| - Antibiotic short-course vs. long-course | Reduced bacteriuria by long-course treatment |
| Others: no difference | |
| - Multiple-dose vs. single-dose treatment | Reduced bacteriuria by multiple-dose treatment |
| Others: no difference |
Table 3.
Incidence of infectious complications and risk factor
Table 4.
Prevalence of antimicrobial resistant bacteria in intestinal flora
Table 5.
Empirical treatment in infectious complication
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