Infection after transrectal ultrasonography-guided prostate biopsy: Increased relative risks after recent international travel or antibiotic use

摘要

Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Septicaemia is the most frequent cause of hospitalization after transtrectal prostate biopsy; fatalities have been reported and the incidence is on the rise. This study shows that men with a history of recent international travel or antibiotic use have up to four times increased risk of septicaemia and hospitalization. When they do occur, infections are usually due to multi-resistant E coli and additional care, e.g. delay before biopsy, different antibiotic prophylaxis or transperineal biopsy, should be considered in these cases. OBJECTIVE To study the infection rate after prostate biopsy in those who have travelled overseas or used antibiotics in the 4 weeks before biopsy. PATIENTS AND METHODS A total of 316 men with a mean (range) age of 61 (45-85) years were studied. All had undergone transrectal ultrasonography (TRUS)-guided prostate biopsy after standard antibiotic prophylaxis. Before their biopsy the patients were risk stratified and a history of recent international travel or antibiotic use was recorded. Those who suffered sufficiently severe infection/sepsis so as to require hospitalization were identified at the end of the study period. The characteristics of these patients and the types of infections were explored and the relative risk (RR) of infection after recent travel or antibiotic use was calculated. RESULTS Of the 316 men, 16 were hospitalized with infection. The group with (n= 16) and without (n= 300) infection were equivalent in age, prostate-specific antigen level, disease status and number of biopsy cores taken. Either recent travel or antibiotic use were independent risk factors for infection [travel: 8/16 vs 76/300; P= 0.04; RR 2.7 and antibiotic use: 4/16 vs 20/300; P= 0.025; RR 4]. There was no significant pattern in the countries visited or the type of antibiotic used. Culture results were positive in 10/16 men, and all cultures grew multiresistant Escherichia coli. The strains were uniformly resistant to ciprofloxacin and amoxycillin, and variably resistant to gentamicin and co-amoxiclav, but nearly all were sensitive to meropenem. All patients made a full recovery after antibiotic and supportive treatment. CONCLUSIONS Either recent international travel or antibiotic use are independent risk factors for severe infection after TRUS-guided prostate biopsy. When infection does occur it should be treated aggressively as the causative agent is usually a multiresistant E. coli.