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Comparative Study
. 2021 Sep;39(9):3423-3432.
doi: 10.1007/s00345-021-03614-8. Epub 2021 Feb 22.

The negative aftermath of prostate biopsy: prophylaxis, complications and antimicrobial stewardship: results of the global prevalence study of infections in urology 2010-2019

Jakhongir F Alidjanov #  1 , Tommaso Cai #  2 , Riccardo Bartoletti  3 , Gernot Bonkat  4 , Franck Bruyère  5   6 , Béla Köves  7 , Ekaterina Kulchavenya  8 , José Medina-Polo  9 , Kurt Naber  10 , Tamara Perepanova  11 , Adrian Pilatz  1 , Zafer Tandogdu  12 , Truls E Bjerklund Johansen #  13   14 , Florian M Wagenlehner #  15
Affiliations
Comparative Study

The negative aftermath of prostate biopsy: prophylaxis, complications and antimicrobial stewardship: results of the global prevalence study of infections in urology 2010-2019

Jakhongir F Alidjanov et al. World J Urol. 2021 Sep.

Abstract

Purpose: To evaluate and report the complications, and to analyse antimicrobial stewardship aspects following prostate biopsies (P-Bx) based on the data from a 9-year global study.

Methods: The primary outcome was to compare complications after P-Bx between patients of two cohorts: 2010-2014 and 2016-2019. Primary outcomes included symptoms of lower and severe/systemic urinary tract infection (LUTIS and SUTIS, respectively), and positive urine culture. Readmission to hospital after P-Bx, need for additional antimicrobial therapy, consumption of different antimicrobial agents for prophylaxis and therapy were evaluated. Students t test and chi-square test were used for comparative analyses.

Results: Outcome data were available for 1615 men. Fluoroquinolones-based prophylaxis rate increased from 72.0% in 2010-2014 to 78.6% in 2015-2019. Overall rates of complications increased from 6 to 11.7% including an increase in symptomatic complications from 4.7 to 10.2%, mainly due to an increase in LUTIS. Rates of patients seeking additional medical help in primary care after P-Bx increased from 7.4 to 14.4%; cases requiring post P-Bx antibiotic treatment increased from 6.1 to 9.7%, most of which received fluoroquinolones. Transperineal P-Bx was significantly associated with LUTIS. Following transrectal P-Bx, 2.8% developed febrile infections and 4.0% required hospitalisation. Two men (0.12%) died after transrectal P-Bx due to sepsis.

Conclusions: The rates of complications after P-Bx tended to increase in time, as well as rates of patients seeking additional medical help in the post-P-Bx period. To reduce the risk of infectious complications and to comply with the principles of antibiotic stewardship, clinicians should switch to the transperineal biopsy route.

Keywords: Antibiotic resistance; Antibiotics; Fluoroquinolones; Prostate biopsy; Prostate cancer.

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Conflict of interest statement

All authors declare the following conflict of interests: all authors are members of the European Section of Infection in Urology (ESIU) of the European Association of Urology (EAU). The GPIU study is organised by the board of the European Section of Infections in Urology (ESIU) and endorsed by the EAU and the EAU Research Foundation (EAU RF). The study is performed in collaboration with the Asian Association of UTI and STI (AAUS), the International Society of Antimicrobial Chemotherapy (ISAC), and the Interregional Association of Clinical Microbiology and Antimicrobial Chemotherapy. The study platform is maintained by the Technische Hochschule Mittelhessen (THM), Germany and sponsored by Merian Iselin Foundation, Switzerland. Otherwise the authors did not receive support from any organisation for the submitted work. No funding was received to assist with the preparation of this manuscript.We thank all the GPIU Investigators who provided essential information (listed in Appendix).

Figures

Fig. 1
Fig. 1
a Proportions of negative outcomes after P-Bx. b Proportions of cases requiring medical assistance after P-Bx
See this image and copyright information in PMC

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