Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

Abstract

Introduction: We have seen an increased risk of infectious complications following transrectal ultrasound-guided prostate biopsy (TRUS-PB). Fluoroquinolone (FQ) antibiotics are common for prophylaxis prior to TRUS-PB. We evaluate whether increasing FQ resistance correlates with increased incidence of post-biopsy infectious complications at our institution.

Methods: We conducted a retrospective chart and electronic health record review on 927 patients who underwent TRUS-PB between January and July of 2012 in Calgary, Alberta, Canada. We prospectively collected the following variables: age, pre-biopsy prostate-specific antigen, and date of biopsy. We documented presentation to an emergency department within 30 days of TRUS-PB for infectious and non-infectious complications.

Results: Of the 927 patients, 58 patients (6.3%) were admitted to the emergency department due to post-TRUS-PB complications within 30 days post-biopsy. The most common infectious complications were sepsis in 21 patients (2.2%), followed by urinary tract infection (UTI) in 9 (0.9%), and prostatitis in 4 (0.4%). We found that 83% of the septic episodes and 66.6% of the UTIs were attributed to ciprofloxacin resistant Escherichia coli (E. coli). The incidence of non-infectious complications was as follows: urinary retention in 12 (1.2%), hematuria in 9 (0.9%), and rectal bleeding in 8 (0.8%).

Conclusion: Our results suggest an increased incidence of infectious complications caused by FQ resistant organisms following TRUS-PB. This finding could be attributed to increasing community resistance to ciprofloxacin. The current antimicrobial prophylactic regimen needs to be re-evaluated, and a novel approach may need to be considered.

Figures

Fig. 1.

Overall distribution of post-transrectal ultrasound-guided prostate biopsy complications. This figure depicts the distribution of 71 complications in 58 patients who presented to the emergency department. Out of 71 cases, 56.3% were due to infections and 43.7% due to non-infectious causes. The “Other” category contains 6 of the following separate complications: peri-anal abscess, scrotal wall abscess, urethritis, epididymo-orchitis, urinary frequency, and gross hematuria with clots.

Fig. 2.

Distribution of microorganisms responsible for sepsis. Out of 21 total cases of sepsis, 18 patients were blood culture positive and 3 patients had no growth in their blood. E. coli was responsible for 14 cases of sepsis and remaining 4 cases were due to each of the following: Klebisella pneumonia, Klebsiella oxytoca, Bacterioides fragilis, and Comamonas species.