Rectal Swabs for Detecting Multidrug Resistant Bacteria Prior to Transrectal Prostate Fusion Biopsy: A Prospective Evaluation of Risk Factor Screening and Microbiologic Findings

Infectious complications of transrectal prostate biopsy in patients receiving targeted antibiotic prophylaxis after urethral and rectal swab versus standard prophylaxis: A prospective comparative study

Background

To evaluate the role of targeted antibiotic prophylaxis (TAP) after rectal and urethral swab cultures compared to empiric antibiotic prophylaxis (EAP) for the prevention of infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-Bx).

Methods

We conducted a prospective comparative study on 141 patients who underwent TRUS-Bx and were allocated in two groups. The first group (n = 71) received EAP with ciprofloxacin and the second (n = 70) received TAP according to rectal and urethral cultures. Post-biopsy infectious complications rates were compared between the two groups. Fluoroquinolone resistance (FQ-R) in the urethral and rectal swabs was recorded. Baseline characteristics were analyzed to assess their relationship with infectious complications and antibiotic resistance.

Results

A total of 8 infectious complications were observed, 7 of them in the EAP group (9.85%) and 1 in the TAP group (1.4%). There was a statistically significant difference in febrile UTIs between the two groups (6 vs 0, P = 0.028). FQ-R rate was 4.3% and 12.9% for rectal and urethral samples, respectively. Recent antibiotic exposure was associated with higher post-biopsy infection rates for EAP group and FQ-R rates for TAP group.

Conclusion

Combination of rectal and urethral swab cultures for TAP was able to detect FQ-R bacteria carriers and was associated with fewer infectious complications compared to EAP.

GEOGRAPHIC VARIATION OF INFECTIOUS COMPLICATIONS FOLLOWING PROSTATE BIOPSY IN THE UNITED STATES: RESULTS FROM A POPULATION-BASED COHORT OF PRIVATELY INSURED PATIENTS

OBJECTIVE

To elucidate regional trends of infectious complications following transrectal ultrasound prostate biopsy (TRUS-PB) from a national, privately-insured database.

MATEREIAL AND METHODS

Using Market Scan, we identified all men who underwent TRUS-PB from 2010 to 2015. Infectious complications (UTI, prostatitis, sepsis) occurring 30 days after the prostate biopsy from emergency room (ER) visits or hospital admissions constituted the primary outcomes. We analyzed unadjusted and adjusted rates of infectious complications from ER visits and hospital admissions per 100 prostate biopsies by state. Multivariable logistic regression analyses were used to identify patient covariates associated with infectious complications.

RESULTS

During the study interval, we identified 193,490 patients who underwent TRUS-PB. The mean age was 57.6 years (SD: 5.0). Over time the unadjusted national rates of infectious complications remained similar from 0.4 ER visits per 100 prostate biopsies in 2010 to 0.2 in 2015 (p=0.83), and 1.2 hospital admissions per 100 prostate biopsies in 2010 to 1.1 in 2015 (p=0.58). Connecticut had the lowest unadjusted infectious complication rate per 100 biopsies at 0.64, whereas West Virginia had the highest at 2.34. Multivariable analysis revealed higher Elixhauser status and patient age were associated with higher odds of infectious complications (p<0.05).

CONCLUSIONS

While rates of infectious complications attributable to prostate biopsies remain relatively stable, significant variation exists at the state level regarding this adverse outcome.

[Antibiotic prophylaxis for transrectal prostate biopsy : In the context of restricted indications for fluoroquinolones and antibiotic stewardship]

BACKGROUND

Transrectal prostate biopsy (TRPB) is the gold standard for prostate cancer diagnosis and among the most common urological interventions. Short-term antibiotic prophylaxis (PAP) is recommended for TRPB. Fluoroquinolone-PAP as standard of care needs to be revaluated due to the restrictions on the use of fluoroquinolone antibiotics by the German Federal Institute for Drugs and Medical Devices.

OBJECTIVES

The aim of the study was to analyze clinical practice of PAP for TRPB with focus on infectious complications and potential differences between fluoroquinolone-PAP and cotrimoxazole-PAP.

METHODS

We performed a retrospective monocentric study of clinical and microbiological characteristics of patients with TRPB between 3 January 2019 and 28 January 2021.

RESULTS

A total of 508 men were included; median age was 68 years. In all, 55.9% of our cohort received cotrimoxazole-PAP and 40.0% fluoroquinolone-PAP. Postinterventional complications occurred in 5.5%, of those 50.0% were infectious complications. Complication rate did not differ between patients with fluoroquinolone-PAP and cotrimoxazole-PAP. Urinary cultures in case of postinterventional complications yielded pathogens with antimicrobial resistance against the used PAP substance indicating selection of resistant bacteria.

CONCLUSION

Cotrimoxazole-PAP for TRPB is not associated with an increase of infectious complications compared to fluoroquinolone-PAP. Cultures obtained prior to TRPB to identify antimicrobial resistance facilitate targeted PAP and therefore can reduce complications.

Positive Culture Prior to Transperineal Prostate Biopsy Was Not Associated with Post-Biopsy Febrile Urinary Tract Infection Development

Purpose

To investigate the association between urine culture before transperineal prostate biopsy and post-biopsy febrile urinary tract infection (fUTI).

Patients and Methods

We retrospectively reviewed 307 patients who underwent urine culture before transperineal prostate biopsy between April 2017 and September 2020. Patients with indwelling urinary catheters (n=7) were excluded. Urine culture was performed 1–3 days before the biopsy, and all patients received prophylactic cefazolin regardless of culture results. A urine culture was defined as positive if cell density was more than 1×10⁵ colony-forming units per mL. Baseline characteristics and the incidence of post-biopsy fUTI were compared between patients showing positive pre-biopsy culture results and those showing negative findings.

Results

Out of 300, seven patients (2.3%) had positive urine culture results before the biopsy. Age (p=0.077); prostate-specific antigen at diagnosis (p=0.267); prostate volume (p=0.78); number of biopsy cores (p=0.277); percentage of patients testing positive for cancer on biopsy (p=0.71); and percentages of patients with a history of biopsy (p>0.999), diabetes mellitus (p=0.604), and immunosuppressive medication use (p>0.999) were similar between the two groups. No patient in the positive urine culture group had post-biopsy fUTI. However, 1.7% (five patients) of the negative urine culture group had the disease (p>0.999) (four patients with prostatitis and one with pyelonephritis). Among them, two patients were diagnosed by urine culture at the time of post-biopsy fUTI.

Conclusion

In asymptomatic patients, positive pre-biopsy cultures were not associated with the development of post-biopsy fUTI.