Skip to main content
SpringerLink
Log in

Emergency hospital admissions attributable to infective complications of prostate biopsy despite appropriate prophylaxis: need for additional infection prevention strategies?

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To report the incidence of emergency admissions attributable to infective complications of transrectal ultrasound-guided prostate biopsy (TGB) and evaluate appropriateness of antimicrobial prophylaxis.

Methods

Retrospective cross-sectional study of patients undergoing TGB at the North West London Hospitals in 2009–2011. Demographic information of patients who had emergency admission within 30 days of TGB, length of hospital stay and microbiology results were obtained from the hospital’s information system, medical records and laboratory information system. All patients received ciprofloxacin and amikacin prophylaxis.

Results

1,419 TGB were performed in 1,276 patients. Forty-eight (3.3 %) patients had emergency admissions. Thirty-three (2.3 %) admissions were due to complications from TGB, while 15 (1 %) were for unrelated reasons. 30/33 (90 %, overall 2.1 %) of admissions from TGB complications were due to confirmed infections or systemic inflammatory response syndrome (SIRS). The rest were admitted with urinary retention. Admission rates due to TGB complications and infection/SIRS remained consistent over the 3 years (2009: TGB complications—2 %, TGB infection/SIRS—1.8 %; 2010: TGB complications—2.4 %, TGB infections/SIRS—2.2 %; 2011: TGB complications—2.6 %, TGB infection/SIRS—2.4 %; P > 0.05). All 11 cases with bacteraemia were caused by ciprofloxacin-resistant but amikacin-susceptible E. coli.

Conclusions

We observed a consistent rate of emergency admissions for complications following TGB; 90 % of these were due to infections. Ciprofloxacin-resistant but amikacin-sensitive E. coli was isolated in all bacteriologically confirmed infections. These results suggest that infective complications of TGB cannot be altogether eliminated despite appropriate antimicrobial prophylaxis. Therefore, additional strategies for reduction in biopsy-related admissions due to infections have to be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH, Loblaw DA, Trachtenberg J, Stanimirovic A, Simor AE, Seth A, Urbach DR, Narod SA (2010) Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 183:963–968

    Article  PubMed  Google Scholar 

  2. Zlotta AR, Nam RK (2012) To biopsy or not to biopsy—thou shall think twice. Eur Urol 61:1115–1117

    Article  PubMed  Google Scholar 

  3. Loeb S, van Den HS, Zhu X, Bangma CH, Schroder FH, Roobol MJ (2012) Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 61:1110–1114

    Article  PubMed  Google Scholar 

  4. Wagenlehner FM, Van OE, Tenke P, Tandogdu Z, Cek M, Grabe M, Wullt B, Pickard R, Naber KG, Pilatz A, Weidner W, Bjerklund-Johansen TE (2012) 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. Eur Urol 63:521–527

    Article  PubMed  Google Scholar 

  5. Batura D, Gopal Rao G (2013) The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention. J Antimicrob Chemother 68:247–249

    Article  CAS  PubMed  Google Scholar 

  6. Patel U, Dasgupta P, Amoroso P, Challacombe B, Pilcher J, Kirby R (2012) Infection after transrectal ultrasonography-guided prostate biopsy: increased relative risks after recent international travel or antibiotic use. BJU Int 109:1781–1785

    Article  PubMed  Google Scholar 

  7. Ganeswaran D, Sweeney C, Yousif F, Lang S, Goodman C, Nabi G (2012) Population-based linkage of health records to detect urological complications and hospitalisation following transrectal ultrasound-guided biopsies in men suspected of prostate cancer. World J Urol (Epub ahead of print). doi:10.1007/s00345-012-0893-2

  8. Livermore DM, James D, Reacher M, Graham C, Nichols T, Stephens P, Johnson AP, George RC (2002) Trends in fluoroquinolone (ciprofloxacin) resistance in enterobacteriaceae from bacteremias, England and Wales, 1990–1999. Emerg Infect Dis 8:473–478

    Article  CAS  PubMed  Google Scholar 

  9. Batura D, Gopal Rao G, Nielsen PB (2010) Prevalence of antimicrobial resistance in intestinal flora of patients undergoing prostatic biopsy: implications for prophylaxis and treatment of infections after biopsy. BJU Int 106:1017–1020

    Article  CAS  PubMed  Google Scholar 

  10. Andrews JM (2009) BSAC standardized disc susceptibility testing method (version 8). J Antimicrob Chemother 64:454–489

    Article  CAS  PubMed  Google Scholar 

  11. Livermore DM, Hawkey PM (2005) CTX-M: changing the face of ESBLs in the UK. J Antimicrob Chemother 56:451–454

    Article  CAS  PubMed  Google Scholar 

  12. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald W (2009) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. 1992. Chest 136(5 Suppl):e28

  13. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM (2011) Complications after prostate biopsy: data from SEER-Medicare. J Urol 186:1830–1834

    Article  PubMed  Google Scholar 

  14. Sanders A, Buchan N (2013) Infection-related hospital admissions after transrectal biopsy of the prostate. ANZ J Surg 83:246–248

    Article  PubMed  Google Scholar 

  15. Rajgopal R, Wang Y, Faber KJ, Izawa JI (2012) Vertebral osteomyelitis following transrectal ultrasound-guided biopsy of the prostate. Can Urol Assoc J 6:E20–E22

    PubMed Central  PubMed  Google Scholar 

  16. Williamson DA, Roberts SA, Paterson DL, Sidjabat H, Silvey A, Masters J, Rice M, Freeman JT (2012) Escherichia coli bloodstream infection after transrectal ultrasound-guided prostate biopsy: implications of fluoroquinolone-resistant sequence type 131 as a major causative pathogen. Clin Infect Dis 54:1406–1412

    Article  CAS  PubMed  Google Scholar 

  17. Rogers BR, Batura D, Gopal Rao G (2013) Escherichia coli bloodstream infection after transrectal ultrasound-guided prostate biopsy: our experience in North West London. Clin Infect Dis 56:465–466

    Article  PubMed  Google Scholar 

  18. Hernandez-Graulau JM (2009) Editorial comment. Sepsis due to fluoroquinolone-resistant Escherichia coli after transrectal ultrasound-guided prostate needle biopsy. Urology 74:338–339

    Article  PubMed  Google Scholar 

  19. Steensels D, Slabbaert K, De Wever L, Vermeersch P, Van Poppel H, Verhaegen J (2012) Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy–should we reassess our practices for antibiotic prophylaxis? Clin Microbiol Infect 18:575–581

    Article  CAS  PubMed  Google Scholar 

  20. Liss MA, Peeples AN, Peterson EM (2011) Detection of fluoroquinolone-resistant organisms from rectal swabs by use of selective media prior to a transrectal prostate biopsy. J Clin Microbiol 49:1116–1118

    Article  PubMed Central  PubMed  Google Scholar 

  21. Batura D, Gopal Rao G, Nielsen PB, Charlett A (2011) Adding amikacin to fluoroquinolone-based antimicrobial prophylaxis reduces prostate biopsy infection rates. BJU Int 107:760–764

    Article  PubMed  Google Scholar 

  22. Adibi M, Hornberger B, Bhat D, Raj G, Roehrborn CG, Lotan Y (2013) Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic prophylaxis. J Urol 189:535–540

    Article  PubMed  Google Scholar 

  23. Ho HS, Ng LG, Tan YH, Yeo M, Cheng CW (2009) Intramuscular gentamicin improves the efficacy of ciprofloxacin as an antibiotic prophylaxis for transrectal prostate biopsy. Ann Acad Med Singap 38:212–216

    PubMed  Google Scholar 

  24. Goto T, Makinose S, Ohi Y, Yamauchi D, Kayajima T, Nagayama K, Hayami H (1998) Diffusion of piperacillin, cefotiam, minocycline, amikacin and ofloxacin into the prostate. Int J Urol 5:243–246

    Article  CAS  PubMed  Google Scholar 

  25. Briffau R, Coloby P, Bruyere F, Ouaki F, Pires C, Dore B, Irani J (2009) One preoperative dose randomized against 3-day antibiotic prophylaxis for transrectal ultrasonography-guided prostate biopsy. BJU Int 103:1069–1073

    Article  Google Scholar 

  26. Hori S, Sengupta A, Joannides A, Balogun-Ojuri B, Tilley R, McLoughlin J (2010) Changing antibiotic prophylaxis for transrectal ultrasound-guided prostate biopsies: are we putting our patients at risk? BJU Int 106:1298–1302

    Article  PubMed  Google Scholar 

  27. Bradley LA, Palomaki GE, Gutman S Samson D, Aronson N (2013) Comparative effectiveness review: prostate cancer antigen 3 testing for the diagnosis and management of prostate cancer. J Urol (Epub ahead of print). doi:10.1016/j.juro.2013.02.005

  28. Helfand BT, Loeb S, Hu Q, Cooper PR, Roehl KA, McGuire BB, Baumann NA, Catalona WJ (2013) Personalized prostate specific antigen testing using genetic variants may reduce unnecessary prostate biopsies. J Urol 189:1697–1701

    Article  PubMed Central  PubMed  Google Scholar 

  29. Portalez D, Mozer P, Cornud F, Renard-Penna R, Misrai V, Thoulouzan M, Malavaud B (2012) Validation of the European Society of Urogenital Radiology scoring system for prostate cancer diagnosis on multiparametric magnetic resonance imaging in a cohort of repeat biopsy patients. Eur Urol 62:986–996

    Article  PubMed  Google Scholar 

  30. Kirby R, Fitzpatrick JM (2012) Optimising repeat prostate biopsy decisions and procedures. BJU Int 109:1750–1754

    Article  PubMed  Google Scholar 

  31. Lorber G, Duvdevani M, Friedman M, Lavy E, Landau EH, Gofrit ON, Pode D, Steinberg D (2013) Sustained-release antibacterial varnish-coated biopsy needle for reduction of infection rates following prostate biopsy-in vitro model. J Endourol 27:277–283

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Mr Manoj Nair for his help with the hospital information systems.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Microbiology, North West London Hospitals NHS Trust, Watford Road, London, HA1 3UJ, UK

    G. Gopal Rao

  2. Department of Urology, Ealing Hospital NHS Trust, Uxbridge Road, Southall, London, UB1 3HW, UK

    Deepak Batura

Authors
  1. G. Gopal Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deepak Batura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deepak Batura.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gopal Rao, G., Batura, D. Emergency hospital admissions attributable to infective complications of prostate biopsy despite appropriate prophylaxis: need for additional infection prevention strategies?. Int Urol Nephrol 46, 309–315 (2014). https://doi.org/10.1007/s11255-013-0529-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-013-0529-5

Keywords

Search

Navigation