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Shigemura K, Fujisawa M. Prevention and management of infectious complications in prostate biopsy: A review. Int J Urol 2021; 28:714-719. [PMID: 33966298 DOI: 10.1111/iju.14572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
Prostate biopsies are common procedures for urologists, performed in order to detect and diagnose prostate cancer. Procedures continue to evolve, for instance, recently there has been an increase in the use of the transperineal approach, and the emergence of antibiotic-resistant bacteria has become a challenge. This review examines the recent prostate biopsy literature as well as the guidelines of three urological associations. We review the recent literature, including our own recent studies, and the Japanese Urological Association, European Association of Urology and American Urological Association guidelines, and summarize the current recommendations regarding the prevention of infectious complications that can occur after prostate biopsy, including the use of antimicrobial agents, and the management and treatment of such complications. Current recommendations include single-dose or 1-day use of oral quinolones for infection control, along with consideration of high-risk patients with diabetes, steroid use, large prostates, or high residual urine volume for instance. Targeted therapies based on the results of rectal swabs carried out prior to transrectal prostate biopsy, which can provide better inhibitory data with regard to post-prostate biopsy infectious complications, can also be considered. In conclusion, oral quinolones for low-risk patients and targeted therapies for high-risk patients are recommended when using a transrectal approach to prostate biopsy, and oral quinolones are recommended when using a transperineal approach. Further randomized controlled trials are necessary to draw more definitive conclusions.
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Affiliation(s)
| | - Masato Fujisawa
- Department of Urology, Kobe University Hospital, Kobe, Hyogo, Japan
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Nakagawa R, Shigehara K, Aoyama S, Urata S, Ofude M, Miyagi T, Nakashima T, Izumi K, Mizokami A. Efficacy of combined prophylactic use of levofloxacin and isepamicin for transrectal prostate needle biopsy: A retrospective single-center study. J Infect Chemother 2019; 25:337-340. [PMID: 30718193 DOI: 10.1016/j.jiac.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/28/2018] [Accepted: 01/10/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the efficacy of a combined regimen of levofloxacin (LVFX) plus isepamicin (ISP) as prophylaxis for transrectal ultrasound-guided needle biopsy of the prostate (TRUSP-Bx). MATERIALS AND METHODS Overall, 562 patients undergoing TRUSP-Bx were included in the present study. All patients were administered a single-dose of oral LVFX (500 mg) in the morning and intravenous ISP (400 mg) 60 min before biopsy. All biopsies were performed via TRUSP-Bx with an 18-gauge needle, and 12-core specimens were routinely obtained. Before initiating antibiotic treatment, urine and blood bacterial cultures were tested to determine the causative microorganisms in the patients with acute bacterial prostatitis. RESULTS Acute bacterial prostatitis developed in three (0.53%) participants. The incidence rates of acute bacterial prostatitis in the low- and high-risk groups were 0.79% and 0.46%, respectively. These patients showed clinical symptoms of acute bacterial prostatitis 12-24 h after their biopsy. Escherichia coli (E. coli) was isolated in the urine or bladder cultures of all of patients. All three isolates were determined to be LVFX-resistant E. coli, although they had good sensitivity to aminoglycosides, cephalosporins, and carbapenems. All patients were administered antibiotic treatment (cephalosporin or carbapenem) immediately and were treated successfully with no evidence of further disease progression. CONCLUSION Antibiotic prophylaxis with LVFX plus ISP was effective, resulting in a lower incidence of acute bacterial prostatitis after TRUSP-Bx in both low- and high-risk patients.
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Affiliation(s)
- Ryunosuke Nakagawa
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan; Integrative Cancer Therapy and Urology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Kazuyoshi Shigehara
- Integrative Cancer Therapy and Urology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan.
| | - Shuhei Aoyama
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Satoko Urata
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Mitsuo Ofude
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Tohru Miyagi
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Takao Nakashima
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Kouji Izumi
- Integrative Cancer Therapy and Urology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Atsushi Mizokami
- Integrative Cancer Therapy and Urology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
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Yamamoto S, Shigemura K, Kiyota H, Wada K, Hayami H, Yasuda M, Takahashi S, Ishikawa K, Hamasuna R, Arakawa S, Matsumoto T. Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition. Int J Urol 2016; 23:814-824. [DOI: 10.1111/iju.13161] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Shingo Yamamoto
- Department of Urology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Katsumi Shigemura
- Department of Urology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
| | | | - Koichiro Wada
- Department of Urology; Okayama University Hospital; Okayama Kagawa Japan
| | - Hiroshi Hayami
- Department of Urology; Graduate School of Medical and Dental Sciences; Kagoshima University; Kagoshima Japan
| | - Mitsuru Yasuda
- Department of Urology; Graduate School of Medicine; Gifu University; Gifu Japan
| | - Satoshi Takahashi
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| | - Kiyohito Ishikawa
- Department of Urology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Ryoichi Hamasuna
- Department of Urology; University of Occupational and Environmental Health; Kitakyushu Fukuoka Japan
| | - Soichi Arakawa
- Department of Urology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
| | - Tetsuro Matsumoto
- Department of Urology; University of Occupational and Environmental Health; Kitakyushu Fukuoka Japan
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Shigemura K, Tanaka K, Yamamichi F, Arakawa S, Fujisawa M. Prophylactic efficacy of cephamycin plus fluoroquinolones in high risk patients on inhibiting infectious complications after transrectal prostate biopsy. J Chemother 2016; 28:513-516. [DOI: 10.1179/1973947815y.0000000059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Samarinas M, Dimitropoulos K, Zachos I, Gravas S, Karatzas A, Tzortzis V. A single dose of meropenem is superior to ciprofloxacin in preventing infections after transrectal ultrasound-guided prostate biopsies in the era of quinolone resistance. World J Urol 2016; 34:1555-1559. [PMID: 26951136 DOI: 10.1007/s00345-016-1800-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/22/2016] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the efficacy of meropenem single dose before transrectal prostate biopsy, instead of ciprofloxacin in the era of fluoroquinolones resistance. METHODS This prospective study included patients with indications for prostatic biopsy from January to December 2014. Those with known resistance in fluoroquinolones or meropenem or with decreased creatinine clearance were excluded. Patients were randomized into two groups, and statistical analysis was carried out. Group A received a 3-day course of ciprofloxacin 500 bid per os starting the day before biopsy. Group B received 1 g meropenem intravenously 1 h prior to the procedure. Patients were followed up for 15 days, and those with lower urinary tract symptoms (LUTS) and fever were called for hospitalization. Urine and blood cultures were obtained. RESULTS A total of 110 patients, 52-75 years old (mean 67.5, median 66) participated in the study, allocated in Groups A and B. After the procedure, 18 patients (32.7 %) of Group A reported macroscopic hematuria, while 10 (18.2 %) reported rectal blood loss. Nine patients (16.3 %) presented because of fever and LUTS. One of them developed septic shock and died in the ICU. Cultures revealed multi-resistant E. coli with high sensitivity to meropenem, and patients were treated accordingly. In Group B, 20 (36.3 %) patients presented with macroscopic hematuria and 9 (16.3 %) with rectal blood loss. One patient returned to hospital with LUTS and fever. Cultures revealed Klebsiella pneumoniae sensitive to colimycine. CONCLUSIONS A single dose of meropenem prior to prostate biopsy is a safe and effective way to avoid the possible infectious complications in high-risk patients.
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Affiliation(s)
- Michael Samarinas
- Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece.
| | - Konstantinos Dimitropoulos
- Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece
| | - Ioannis Zachos
- Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece
| | - Stavros Gravas
- Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece
| | - Anastasios Karatzas
- Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece
| | - Vasileios Tzortzis
- Department of Urology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110, Mezourlo, Larissa, Greece
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Lee SJ. Infection after transrectal ultrasound-guided prostate biopsy. Korean J Urol 2015; 56:346-50. [PMID: 25964834 PMCID: PMC4426505 DOI: 10.4111/kju.2015.56.5.346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/10/2015] [Indexed: 11/18/2022] Open
Abstract
Infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-Bx) appear to be increasing, which reflects the high prevalence of antibiotic-resistant strains of Enterobacteriaceae. Identifying patients at high risk for antibiotic resistance with history taking is an important initial step. Targeted prophylaxis with a prebiopsy rectal swab culture or augmented antibiotic prophylaxis can be considered for patients at high risk of antibiotic resistance. If infectious complications are suspected, the presence of urosepsis should be evaluated and adequate antibiotic treatment should be started immediately.
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Affiliation(s)
- Seung-Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol 2013; 64:876-92. [PMID: 23787356 DOI: 10.1016/j.eururo.2013.05.049] [Citation(s) in RCA: 676] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/24/2013] [Indexed: 12/11/2022]
Abstract
CONTEXT Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer screening and treatment. OBJECTIVE To perform a systematic review of complications from prostate biopsy. EVIDENCE ACQUISITION A literature search was performed using PubMed and Embase, supplemented with additional references. Articles were reviewed for data on the following complications: hematuria, rectal bleeding, hematospermia, infection, pain, lower urinary tract symptoms (LUTS), urinary retention, erectile dysfunction, and mortality. EVIDENCE SYNTHESIS After biopsy, hematuria and hematospermia are common but typically mild and self-limiting. Severe rectal bleeding is uncommon. Despite antimicrobial prophylaxis, infectious complications are increasing over time and are the most common reason for hospitalization after biopsy. Pain may occur at several stages of prostate biopsy and can be mitigated by anesthetic agents and anxiety-reduction techniques. Up to 25% of men have transient LUTS after biopsy, and <2% have frank urinary retention, with slightly higher rates reported after transperineal template biopsy. Biopsy-related mortality is rare. CONCLUSIONS Preparation for biopsy should include antimicrobial prophylaxis and pain management. Prostate biopsy is frequently associated with minor bleeding and urinary symptoms that usually do not require intervention. Infectious complications can be serious, requiring prompt management and continued work into preventative strategies.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA.
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Williamson DA, Barrett LK, Rogers BA, Freeman JT, Hadway P, Paterson DL. Infectious Complications Following Transrectal Ultrasound-Guided Prostate Biopsy: New Challenges in the Era of Multidrug-Resistant Escherichia coli. Clin Infect Dis 2013; 57:267-74. [DOI: 10.1093/cid/cit193] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Adibi M, Hornberger B, Bhat D, Raj G, Roehrborn CG, Lotan Y. Reduction in Hospital Admission Rates Due to Post-Prostate Biopsy Infections After Augmenting Standard Antibiotic Prophylaxis. J Urol 2013; 189:535-40. [DOI: 10.1016/j.juro.2012.08.194] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Mehrad Adibi
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brad Hornberger
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deepa Bhat
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ganesh Raj
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, Texas
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