Infective Complications After Prostate Biopsy: Outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, A Prospective Multinational Multicentre Prostate Biopsy Study

Department of Urology, Paediatric Urology and Andrology of the Justus-Liebig-University, Giessen, Germany.
European Urology (Impact Factor: 13.94). 03/2013; 63(3):521-527. DOI: 10.1016/j.eururo.2012.06.003


Infection is a serious adverse effect of prostate biopsy (P-Bx), and recent reports suggest an increasing incidence.
The aim of this multinational multicentre study was to evaluate prospectively the incidence of infective complications after P-Bx and identify risk factors.
The study was performed as an adjunct to the Global Prevalence Study of Infections in Urology (GPIU) during 2010 and 2011. Men undergoing P-Bx in participating centres during the 2-wk period commencing on the GPIU study census day were eligible. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Baseline data were collected and men were questioned regarding infective complications at 2 wk following their biopsy. The Fisher exact test, Student t test, Mann-Whitney U test, and multivariate regression analysis were used for data analysis.
A total of 702 men from 84 GPIU participating centres worldwide were included. Antibiotic prophylaxis was administered prior to biopsy in 98.2% of men predominantly using a fluoroquinolone (92.5%). Outcome data were available for 521 men (74%). Symptomatic urinary tract infection (UTI) was seen in 27 men (5.2%), which was febrile in 18 (3.5%) and required hospitalisation in 16 (3.1%). Multivariate analysis did not identify any patient subgroups at a significantly higher risk of infection after P-Bx. Causative organisms were isolated in 10 cases (37%) with 6 resistant to fluoroquinolones. The small sample size per participating site and in compared with other studies may have limited the conclusions from our study.
Infective complications after transrectal P-Bx are important because of the associated patient morbidity. Despite antibiotic prophylaxis, 5% of men will experience an infective complication, but none of the possible factors we examined appeared to increase this risk. Our study confirms a high incidence of fluoroquinolone resistance in causative bacteria.

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    • "An important point for future evaluation is the presence of levofloxacin resistance of fecal E. coli. One study showed that the presence of fecal E. coli strains resistant to levofloxacin represents an important development of infectious complications in BTRP risk [13]. To date there are few randomized studies showing the use of result of rectal swab culture for prophylactic antibiotics use in BTRP [16] [17] [18] "
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    • "Various procedure-related complications including pain on biopsy sites, hematuria, hematochezia, acute urinary retention, urinary tract infection (UTI) etc. have been reported and major complications sometimes present as much more serious problems to both patients and urologists. Febrile UTIs or urosepsis frequently require hospital admission for supportive care and antibiotic treatment (8, 9). "
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    • "In the United States, a retrospective analysis of the Surveillance Epidemiology and End Results prostatic biopsies database, consisting of older subjects (median age: 73 yr), documented a 2.65-fold increased risk of hospitalization within 30 d (6.9% vs 2.7% in controls) [3]. There is a recent trend toward an increase of infective biopsy complications due to increased germ resistance to fluoroquinolones [4], and the present consensus is that local anesthetic given as a periprostatic nerve block is more effective than intrarectal instillation in alleviating pain from ultrasound-guided prostatic biopsy [5]. "
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