Prevention of sepsis prior to prostate biopsy

Abstract

PurposeUrosepsis is the most feared complication of transrectal prostate biopsy. The incidence may be increasing from <1% to 2%–3% in contemporary series. Historically, fluoroquinolones have been effective antibiotic prophylaxis to prevent infective complications but antibiotic resistance is increasing. The increase in antibiotic resistance may contribute to reported increases in urosepsis and hospitalization after transrectal biopsy. This article will review other methods clinicians may employ to reduce the incidence of infective complications after prostate biopsy.Materials and MethodsA systematic review of the literature was conducted using literature databases PubMed and Ovid MEDLINE in August 2015 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) criteria.ResultsEffective strategies to reduce infective complications after transrectal prostate biopsy include augmented prophylaxis with other antibiotics, rectal swab culture directed antibiotic prophylaxis or a transperineal biopsy approach. Needle disinfection, minimizing the number of biopsy needles and rectal disinfectants may also be of use. These methods may be of particular utility in patients with risk factors for developing urosepsis such as recent antibiotic use and overseas travel.ConclusionsThe scientific literature describes various techniques designed to reduce infective complications caused by prostate biopsy. Clinicians should consider incorporating these novel techniques into their contemporary practice.

Outcomes of transperineal and transrectal ultrasound-guided prostate biopsy

“…However, there are complications associated with the use of TRUSPB. Most notably, because the procedure is performed via the rectum, there is a risk of postprocedural sepsis; the incidence of sepsis ranged was 2% to 4% in contemporary series, 4,5 and sepsis-related mortality has also been reported. 6 An increasing number of studies have demonstrated success in cancer diagnosis with extended biopsy using transperineal ultrasoundguided prostate biopsy (TPUSPB).…”

“…10 Some authors have suggested that TPUSPB may be performed without antibiotic prophylaxis, thus reducing the risk of generating antibiotic resistance. 4 Based on these potential benefits, our centre introduced TPUSPB beginning in January 2018. Subsequently, we have completely replaced TRUSPB with TPUSPB.…”

Antibiotic prophylaxis for transrectal ultrasound-guided prostate needle biopsy: Compared efficacy of ciprofloxacin vs. the ciprofloxacin/fosfomycin tromethamine combination

“…Electronic medical records of all patients were reviewed for demographic, clinical and microbiological data. Clinical information included emergency consultations, hospital admissions and risk factors for post-PNB infection distributed into comorbidities, infectious and urological risk factors 3,4,7,10,13 . Microbiological data included available midstream-voided urine and blood cultures as well as the pathogens and antibiotic susceptibility testing, as reported by clinical microbiological laboratories.…”

“…Recent studies report rising rates of post-PNB infections associated with emergent FQ resistant E. coli and extended-spectrum -lactamase producing E. coli (ESBL), raising concerns about efficacy of these antibioprophylaxis regimens 2,[4][5][6] . On the other hand, various mitigating strategies are suggested in the literature: rectal swab screening with directed antibioprophylaxis 7,8 , switching antibioprophylaxis 7,[9][10][11] and transperineal biopsy approach 2,7 . Recently, some authors pointed out fosfomycin tromethamine (FOS) as being an attractive alternative, because of its adequate levels in prostatic tissue obtained with a single 3g oral dose, the low level of bacterial resistance, its broad spectrum of activity including multidrug resistant organisms, and its good safety profile [10][11][12] .…”

A Retrospective Comparison of Transrectal and Transperineal Prostate Biopsies: Experience of a Single Surgeon

“…Various techniques have been proposed, but as yet, the evidence to support these interventions is limited. A systematic review published by Toner and colleagues 7 suggested that at present, there is little evidence to support the use of simple techniques such as cleansing or disinfecting enemas or needle disinfection to decrease prostate biopsy-associated sepsis rates. Toner and colleagues suggested, however, that there is some evidence to support the efficacy of augmented antibiotic prophylaxis, targeted antibiotic prophylaxis, and use of the transperineal method to decrease rates of prostate biopsy-associated infection.…”