Increasing Risk of Infectious Complications After Transrectal Ultrasound-Guided Prostate Biopsies: Time to Reassess Antimicrobial Prophylaxis?

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• 作者：Alex Carignan ; Jean-Fran?ois Roussy ; V¨¦ronique Lapointe ; Louis Valiquette ; Robert Sabbagh ; Jacques P¨¦pin
• 关键词：Bacteremia ; Ciprofloxacin ; Prostate biopsy ; Resistance ; Urinary tract infections
• 刊名：European Urology
• 出版年：2012
• 出版时间：September, 2012
• 年：2012
• 卷：62
• 期：3
• 页码：453-459
• 全文大小：235 K

文摘

Background

An increasing risk of infectious complications following transrectal ultrasound-guided prostate needle biopsy (PNB) has been observed recently in some centers.

Objective

To delineate the risk factors associated with post-PNB bacteremia and/or urinary tract infection (UTI) and determine why this risk has risen over time.

Design, setting, and participants

A case-control study in a Canadian tertiary-care center. Cases were all patients who developed bacteremia and/or UTIs after PNB between 2002 and 2011; controls were randomly selected among patients who underwent a PNB without such complications.

Outcome measurements and statistical analysis

Crude and adjusted odds ratios and their 95 % confidence intervals were calculated using logistic regression.

Results and limitations

A total of 5798 PNBs were performed during the study period, following which there were 48 cases of urinary sepsis (42 % with bacteremia). The incidence increased from 0.52 infections per 100 biopsies in 2002-2009 to 2.15 infections per 100 biopsies in 2010-2011 (p < 0.001). Escherichia coli was the predominant pathogen (75 % of cases). Among 42 patients whose post-PNB infection was caused by aerobic or facultative Gram-negative rods, 22 patients (52 % ) were infected by pathogens resistant to ciprofloxacin. Independent risk factors for post-PNB infection were diabetes, hospitalization during the preceding month, chronic obstructive pulmonary disease, and performance of the biopsy in 2010-2011. In 2010-2011, the minimal inhibitory concentrations for ciprofloxacin increased compared with 2002-2009 (p < 0.03). The major limitation of the study was its retrospective hospital-based nature, which hampered data collection on outpatient antibiotic prescriptions.

Conclusions

In the past 2 yr, ciprofloxacin resistance contributed to the increasing incidence of post-PNB infections in our center. Novel antibacterial prophylaxis approaches need to be evaluated.