Infectious complications of prostate biopsy: winning battles but not war
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TOPIC PAPER
Infectious complications of prostate biopsy: winning battles but not war Okan Derin1 · Limírio Fonseca2 · Rafael Sanchez‑Salas3 · Matthew J. Roberts4,5,6 Received: 10 September 2019 / Accepted: 30 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Prostate biopsy is a standard tool for diagnosing prostate cancer, with more than 4 million procedures performed worldwide each year. Infectious complications and economic burden are reportedly rising with continued use of trans-rectal ultrasound-guided biopsy, despite the transperineal approach being associated with less infectious complications. Objective and methods In this review, the contemporary literature on pathophysiology, epidemiology, risk factors, causative organisms and emerging approaches for prevention of infectious complications are outlined. Results Management of infectious complications after TRUSB has caused significant financial burden on health systems. The most frequent causative agents of infectious complications after prostate biopsy are Gram-negative bacilli are particularly concerning in the era of antibiotic resistance. Increasing resistance to fluoroquinolones and beta-lactam antibiotics has complicated traditional preventive measures. Patient- and procedure-related risk factors, reported by individual studies, can contribute to infectious complications after prostate biopsy. Conclusions Recent literature shows that the transrectal ultrasound-guided prostate biopsy results in higher infectious complication rate than the transperineal prostate biopsy. NAATs, recently introduced technique to detect FQr may detect all antibiotic-resistant rectal microbiota members—included MDRs—although the technique still has limitations and economical burdens. Transient solutions are escalating antibiotic prophylaxis and widening the indications for TPB. Keywords Prostate biopsy · Infectious complications · Antimicrobial resistance · Preventive measures
Introduction
* Okan Derin [email protected] 1
International School of Medicine, Medipol Mega Hospital, Istanbul Medipol University, Bagcilar, 34214 Istanbul, Turkey
2
Hospital das Clinicas da Universidade de São Paulo, São Paulo, Brazil
3
Department of Urology, L’Institut Mutualiste Montsouris, Paris, France
4
Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
5
Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
6
Nepean Urology Research Group, Kingswood, NSW, Australia
Prostate biopsy is widely accepted as a standard tool in diagnosing prostate cancer and over four-million procedures are performed each year globally [1]. The procedure can be performed using transrectal ultrasound (TRUS) guidance and most commonly by the transrectal (TR) approach, with the transperineal (TP) approach being a viable alternative [2, 3]. While TP biopsy (TPB) is associated with less infectious complications for similar diagnostic accuracy, this method has increased
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