Prolonged antibiotic therapy increases risk of infection after transrectal prostate biopsy: A case report after pancreasectomy and review of the literature

Abstract

Infection due to prostate biopsy afflicted more than 5% of patients and is the most common reason for hospitalization. A large series from US SEER-Medicare reported that men undergoing biopsy were 2.26 times more likely to be hospitalized for infectious complications within 30 days compared with randomly selected controls. The factors predicting a higher susceptibility to infection remain largely unknown but some authors have higlighted in the etiopathogenesis the importance of the augmented prevalence of ciprofloxacin resistant variant of bacteria in the rectum flora. We present one case of sepsis after transrectal prostate biopsy in a patient with history of pancreatic surgery. Based on our experience patients candidated to prostate biopsy with transrectal technique with history of recent major surgery represent an high risk category for infective complication. Also major pancreatic surgery should be consider an high risk category for infection. A transperineal approach and preventive measures (such as rectal swab) should be adopted to reduce biopsy driven infection. antibiotics presented 9 days after 12 core transrectal prostate biopsy. Ciprofloxacin 1000 mg extended release was given before biopsy according local guidelines (4), preoperative urine culture was negative. The patient was submitted in the June 2013 to cephalo-pancreatic-duodenectomy and reconstructive surgery due to a carcinoma of Vater papilla; surgical recovery was complicated by infection and treated with attention. During hospitalization he was treated with prolonged antibiotics (imipenem-cilastatin). We consider a review of the literature to establish factors associated with higher susceptibility to infection and to highlight possible relationship between pancreatic surgery and risk of infective complications during prostate biopsy. Pubmed search was performed using key words: prostate biopsy; urosepsis; pancreatitis and pancreatic surgery, 76 papers were retrieved and 25 were considered as pertinent to our aim. RESULTThe infective course showed 2 episodes of recurrence with fever and urine culture positive for E. coli with multidrug resistant. The first hospital admission: after an empiric therapy with ciprofloxacin the patient was treated with i.v. association (ceftriaxone and piperacillintazobactam) for 10 days, then discharged with oral antibiotics. After 15 days, the second hospital admission was due to fever (39°C) and urinary symptoms and the hospital stay was 5 days. Transrectal ultrasound was negative for abscess or significant post-void urinary residue. A second cycle of i.v. antibiotic association (ceftriaxone and piperacillin-tazobactam) resolved the fever. Further follow-up was uneventful. DISCUSSIONSeveral reports have recently suggested an increased rate of infective complications following transrectal prostate biopsy in both North America (5) and Europe (6). The reasons for this increase and the factors associated with a higher susceptibility to infection remain largely unknown. Based on our experience, candidates to transre...