Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy: first report from the Norwegian Patient Registry

  • Truls E. Bjerklund JohansenEmail author
  • Per-Henrik Zahl
  • Eduard Baco
  • Riccardo Bartoletti
  • Gernot Bonkat
  • Franck Bruyere
  • Tommaso Cai
  • Mete Cek
  • Ekaterina Kulchavenya
  • Bela Köves
  • Vladimir Mouraviev
  • Adrian Pilatz
  • Zafer Tandogdu
  • Peter Tenke
  • Florian M. E. Wagenlehner
Topic Paper



A 68-year-old man died of cerebral arterial embolism 6 days after transrectal prostate biopsy with a single p.o. dose of trimethoprim sulfamethoxazole (TMP-SMX) as prophylaxis. The case precipitated analysis of local antibiotic resistance and complication rates.

Materials and methods

Data on E. coli resistance from Oslo University Hospital and national data on hospitalizations and mortality after biopsy were retrieved from local microbiology files and the Norwegian Patient Registry (NPR) 2011–2017.


Urine E. coli resistance against TMP-SMX increased from 35% in 2013 to more than 60% in 2015. For ciprofloxacin, the resistance increased from 15% in 2013 to about 45% in 2016. The highest annual E. coli resistance in blood cultures for TMP-SMX and ciprofloxacin was 37% and 28%, respectively. 10% of patients were hospitalized with a diagnosis of infection within the first 60 days after biopsy and there was a relative increase in mortality rate of 261% within the first 30 days. Due to the severity of the figures, the story and the NPR data were published in Norway’s leading newspaper and were succeeded by a series of chronicles and commentaries.


Several critical points of the biopsy procedure were not performed according to current standards. We believe that the patient might have died of septic embolism after biopsy. As a result of the findings and the debate, local practice was changed from transrectal to transperineal prostate biopsies.


Prostate biopsy Complications Hospitalization Death Antibiotic resistance 



Are Brean, Chief editor of The Journal of the Norwegian Medical Association who recommended that the case should be presented in a newspaper. Lene Skogström, journalist in Aftenposten who made the case available to the public.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Truls E. Bjerklund Johansen
    • 1
    • 2
    • 3
    Email author
  • Per-Henrik Zahl
    • 4
  • Eduard Baco
    • 1
  • Riccardo Bartoletti
    • 5
  • Gernot Bonkat
    • 6
  • Franck Bruyere
    • 7
    • 8
  • Tommaso Cai
    • 9
  • Mete Cek
    • 10
  • Ekaterina Kulchavenya
    • 11
  • Bela Köves
    • 12
  • Vladimir Mouraviev
    • 13
    • 14
  • Adrian Pilatz
    • 15
  • Zafer Tandogdu
    • 1
    • 2
  • Peter Tenke
    • 12
  • Florian M. E. Wagenlehner
    • 15
  1. 1.Department of UrologyOslo University HospitalOsloNorway
  2. 2.Institute of Clinical MedicineUniversity of OsloOsloNorway
  3. 3.Institute of Clinical MedicineAarhus UniversityAarhusDenmark
  4. 4.Domain for Mental and Physical HealthNorwegian Institute of Public HealthOsloNorway
  5. 5.Department of UrologyUniversity of PisaPisaItaly
  6. 6.Department of Urologyalta uro AGBaselSwitzerland
  7. 7.UrologieToursFrance
  8. 8.Université Francois Rabelais de Tours, PRES Centre val de LoireToursFrance
  9. 9.Department of UrologySanta Chiara HospitalTrentoItaly
  10. 10.Department of UrologyMedical Faculty of Trakya UniversityEdirneTurkey
  11. 11.Urogenital DepartmentNovosibirsk Research TB InstituteNovosibirskRussian Federation
  12. 12.South-Pest Teaching HospitalBudapestHungary
  13. 13.University of Central FloridaOrlandoUSA
  14. 14.Central Florida Cancer InstituteDavenportUSA
  15. 15.Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie Universitätsklinikum Gießen und Marburg GmbHStandort Gießen Justus-Liebig-Universität GießenGiessenGermany

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