Journal List > Urogenit Tract Infect > v.11(1) > 1084196

Hwang, Yu, Jung, Kwon, Lee, Kim, Chang, Yoon, Shim, Kim, Lee, Huh, Lim, Jo, Min, Lee, Kim, Kim, Lee, Yang, Lee, Han, Bae, Choe, Lee, Chung, Na, Yang, Park, Kim, Kim, Cho, Han, Cho, Ha, and Park: Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study

Abstract

Purpose

Recent studies have highlighted an increasing trend of infectious complications due to fluoroquinolone-resistant organisms among men undergoing transrectal prostate biopsy. This study evaluated the current incidence of infective complications after trans-rectal prostate biopsy for identification of risk factors in Korean men who received fluoroquinolone prophylaxis.

Materials and Methods

A prospective, multicenter study was conducted in Korea from January to December 2015. Prostate biopsies performed with fluoroquinolone prophylaxis during 3 months in each center were included. A pre-biopsy questionnaire was used for identification of patient characteristics. Clinical variables including underlying disease, antibiotic prophylaxis, enema, povidone-iodine cleansing of the rectum, and infectious complications were evaluated. The primary outcome was the post-biopsy infection rate after fluoroquinolone prophylaxis. Univariable and multivariable analyses were used for identification of risk factors for infectious complications.

Results

The study included 827 patients, of whom 93 patients (11.2%) reported receiving antibiotics in the previous 6 months and 2.5% had a history of prostatitis. The infectious complication rate was 2.2%. Post-biopsy sepsis was reported in 2 patients (0.2%). In multivariable analysis predictors of post-biopsy sepsis included person performing biopsy (adjusted odds ratio [OR], 4.05; 95% confidence interval [CI], 1.31–12.5; p=0.015) and operation history within 6 months (adjusted OR, 5.65; 95% CI, 1.74–18.2; p=0.004).

Conclusions

The post-prostate biopsy infectious complication rate in this study was 2.2%. Person performing biopsy (non-urologists) and recent operation history were independent risk factors for infectious complications after trans-rectal prostate biopsy.

References

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Table 1.
Baseline characteristics of enrolled patients
Variable Value (n=827)
Age (y) 69 (63–74)
PSAa) (ng/dl) 1.87 (1.51–2.43)
Prostate volume (ml) 37.2 (27.0–51.7)
Biopsy operators
Urologist 423 (51.1)
Non-urologists 404 (48.9)
Biopsy results
BPH 512 (61.9)
Prostate cancer 313 (37.8)
ASAP 2 (0.2)
Number of biopsy cores
<12 345 (41.7)
≥12 482 (58.3)
Health care-associated patients 98 (11.9)
Health care workers
Non-medical 806 (97.5)
Medical service provider 20 (2.4)
Medical service provider's family 1 (0.1)
Travel history within 4 wk 20 (2.4)
Diabetes mellitus 122 (14.8)
Operation history within 6 mo 48 (5.8)
Prostatitis history within 6 mo 21 (2.5)
UTI history within 6 mo 12 (1.5)
Prior prostate biopsy
No 794 (96.0)
<12 mo 23 (2.8)
≥12 mo 10 (1.2)
Antibiotics exposure history 93 (11.2)
Duration of Antibiotics
<3 d 104 (12.6)
≥3 d 723 (87.4)
Local anesthesia used 252 (30.5)
Povidone iodine used 827 (100)
Enema
No 21 (2.5)
Rectal 789 (95.4)
Oral 17 (2.1)
Infectious complication 18 (2.2)
Hospitalization due to infectious complications 16 (1.9)
Fever 17 (2.1)
UTI, acute prostatitis 15 (1.8)
Bacteremia 8 (1.0)
Sepsis 2 (0.2)

Values are presented as median (interquartile range) or number (%). PSA: prostate specific antigen, BPH: benign prostate hyperplasia, ASAP: atypical small acinar proliferation, UTI: urinary tract infection.

a )Logarithmically adjusted.

Table 2.
Univariable and multivariable analysis of clinical parameters affecting infectious complications after prostate biopsy
Variable Odds ratio p-value Adjusted odds ratio p-value
Age 0.96 (0.91–1.01) 0.088    
Person performing biopsy (non-urologists vs. urologists) 3.76 (1.22–11.5) 0.020 4.05 (1.31–12.5) 0.015
Number of biopsy cores (vs. <12) 2.85 (1.06–7.69) 0.038    
Health care-associated 2.96 (1.03–8.49) 0.043    
Health care workers
Medical service provider NA 0.998    
Medical service provider's family NA 1    
Travel history within 4 wk NA 0.998    
Diabetes mellitus 1.67 (0.54–5.17) 0.371    
Operation history within 6 mo 4.96 (1.57–15.7) 0.006 5.65 (1.74–18.2) 0.004
Prostatitis history within 6 mo 2.32 (0.29–18.2) 0.424    
UTI history within 6 mo 4.26 (0.52–34.9) 0.176    
Prior prostate biopsy (vs. no)
<12 mo NA 0.998    
≥12 mo NA 0.999    
Antibiotics exposure history 4.14 (1.51–11.3) 0.006    
Duration of antibiotic use (vs. ≥3 d) 2.48 (0.32–18.8) 0.380    
Local anesthesia used 0.28 (0.06–1.22) 0.091    
Enema
Rectal NA 0.998    
Oral NA 1    

UTI: urinary tract infection, NA: not available.

Table 3.
Culture results
Culture Pathogens ESBL positivity Fluoroquinolone resistance
Urine (n=2) E. coli +
E. coli +
Blood (n=3) E. coli + +
E. coli +
Staphylococcus aureus
Blood and urine (n=5) E. coli + +
E. coli + +
Citrobacter freundii
E. coli + +
E. coli +

ESBL: extended-spectrum beta lactamase, E. coli: Escherichia coli.

Table 4.
Escherichia coli resistance patterns
Antibiotics Urine (n=2) Blood (n=2) Blood and urine (n=4)
Amoxicillin/clavulanate Resistance Sensitive Sensitive Sensitive Intermediatte Resistance Resistance Sensitive
Piperacillin/tazobactam Sensitive Sensitive Sensitive Sensitive Sensitive Sensitive Sensitive Sensitive
Trimethoprim-sulfamethoxazole Resistance Sensitive Sensitive Resistance Sensitive Resistance Resistance Resistance
Levofloxacin Not tested Intermediatte Not tested Not tested Not tested Resistance Not tested Not tested
Ciprofloxacin Resistance Resistance Intermediate Resistance Resistance Resistance Resistance Resistance
Gentamicin Resistance Resistance Sensitive Not tested Resistance Sensitive Sensitive Sensitive
Amikacin Sensitive Sensitive Sensitive Sensitive Sensitive Sensitive Sensitive Sensitive
Imipenem Sensitive Sensitive Sensitive Sensitive Sensitive Sensitive Sensitive Sensitive
Meropenem Not tested Sensitive Sensitive Sensitive Not tested Sensitive Not tested Not tested
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