Research Article: Rectal Culture-Guided Targeted Antimicrobial Prophylaxis Reduces the Incidence of Post-Operative Infectious Complications in Men at High Risk for Infections Submitted to Transrectal Ultrasound Prostate Biopsy – Results of a Cross-Sectional Study

Date Published: January 25, 2017

Publisher: Public Library of Science

Author(s): Luca Boeri, Matteo Fontana, Andrea Gallioli, Stefano Paolo Zanetti, Michele Catellani, Fabrizio Longo, Barbara Mangiarotti, Emanuele Montanari, Peter C Black.


The role of rectal culture-guided antimicrobial prophylaxis (TAP) in reducing infectious complications (IC) after transrectal-ultrasound prostate biopsy (TRUSPBx) is conflicting. We assessed the prevalence of IC in a cohort of men at high risk for IC submitted to TRUSPBx and treated with either TAP or empirical prophylaxis (EAP). Data from 53 patients at high risk for IC undergoing TRUSPBx were collected. Patients who did not receive a rectal swab (RS) were treated with EAP with fluoroquinolones (FQs). Of those who received the RS, patients with FQ-susceptible organisms received ciprofloxacin while those with FQ-resistant organisms received TAP. Office visits were scheduled to investigate the rate of complication at day 7 and 30 after TRUSPBx. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Descriptive statistics and logistic regression models detailed the association between clinical parameters and IC rate. Out of 53 men, 17 (32.1%) had RS while 36 (67.9%) did not. All RS cultures were positive for E. Coli and 4 (23.5%) reported FQ-resistant pathogens. Considering risk factors for IC, no difference was found in terms of CCI, rate of diabetes, UTIs or recent antibiotic utilization between groups. Overall, 12 (22.6%) men reported IC, with a greater proportion of them belonging to the group treated with EAP (30.6% vs 5.9%; p = 0.045). Of these, 9 (25.0%) patients, all treated with EAP, developed post biopsy UTIs. E. Coli sustained all UTIs and 7 (77.7%) were FQ resistant. At multivariable analysis, CCI≥1, a history of UTIs/prostatitis and recent antibiotic utilization (all p<0.04) were the most powerful predictors for ICs. In conclusion, we found that compared to EAP, TAP significantly reduces ICs, in men at high risk for post TRUSPBx IC. Patients at risk for IC, especially those with recent antibiotic utilization, CCI≥1 and a history of UTIs/prostatitis before biopsy, could benefit from TAP.

Partial Text

Prostate cancer (PCa) is the most common non-skin cancer in elderly males in Europe. Transrectal ultrasound-guided prostate biopsy (TRUSPBx) is currently the standard tissue-sampling technique for the histological diagnosis of PCa, with over one million patients undergoing biopsy each year in the United States [1]. Even if TRUSPBx is generally considered a safe procedure, it may be accompanied by clinical complications ranging from pain, haematospermia and haematuria to severe infectious complications such as urinary tract infections (UTIs), prostatitis and sepsis [2]. Studies have shown high rates of post TRUSPBx infectious complications (PTICs), with evidence of an increasing trend [2,3]. Escherichia Coli (E. coli) is the most commonly implicated pathogen in PTICs, present in 75–90% of cases [4].

Complete data collection was available for 17 (32.1%) patients who received RS and 36 (67.9%) who did not received RS (-RS) before TRUSPBx.

This study was designed to evaluate PTIC prevalence in a selected cohort of men at high risk for infectious complications after prostate biopsy who received a RS culture and subsequent TAP, compared to a group of same-risk men not receiving RS and treated with EAP before TRUSPBx. Of clinical importance, patients treated with EAP reported higher rates of PTICs compared to those treated with TAP. Importantly, 23.5% of patients with RS culture results were found to have FQ-resistant E. coli. Moreover, recent antibiotics utilization, CCI≥1 and a history of UTIs/prostatitis before biopsy were the most powerful predictors for PTICs.

This cross-sectional study provides new clinically-relevant evidence that RS-guided prophylaxis significantly reduces PTICs compared to EAP in a cohort of men at high risk for infectious complications. Importantly, 23.5% of patients with RS culture results were found to have FQ-resistance E. coli. Moreover, recent antibiotic utilization, CCI≥1 and a history of UTIs/prostatitis before biopsy emerged as the most powerful predictors for PTICs. Overall, the current results indicate a clinical need for comprehensive investigations of potential risk factors for PTICs in order to select candidates who would benefit most form TAP, keeping in mind the extraordinary epidemiological and socio-economical impact of these infectious complications.




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