A significant percentage of patients with transrectal biopsy-related infections have positive blood cultures but negative urine cultures. A literature review and meta-analysis.

Infectious complications after transrectal prostate biopsy are rare. Nevertheless, since these are frequent procedures, the burden of infectious complications is high. Considering the increasing antimicrobial resistance, microbiological confirmation is important to guide antimicrobial therapy.

We reviewed PubMed for original studies providing concurrent urine and blood culture data in symptomatic patients with transrectal biopsy-related infectious complications. We performed a proportions meta-analysis (with MedCalc) and calculated the pooled yield of urine and blood cultures and the pooled discordance rate between urine and blood cultures.

Our review identified 41 studies, involving 852 patients with infectious complications after transrectal prostate biopsy and sufficient data to calculate discordance. The pooled yield of urine cultures was 64.6% (95% CI: 56.2-72.3%, I2 83%), the pooled yield of blood cultures was 43% (95% CI: 36.5-49.7%, I2 74%) and the pooled discordance rate was 14% (95% CI: 10.6-17.8%, I2 53%). In subgroup analyses the pooled discordance was; 19.6% (95% CI: 11.8-28.9%, I2 31%) in 113 patients presenting within 2 calendar days after the biopsy and 11.2% (95% CI: 4.5-20%, I2 47%) in 143 patients presenting with fever and symptoms of lower urinary tract symptoms. The statistical and methodological heterogeneity of included studies was high.

Obtaining blood cultures is reasonable in all patients presenting with systemic symptoms suggestive of infection after a transrectal prostate biopsy. Blood cultures can provide additional microbiological data in about 1 of 7 patients with post-biopsy infectious complications. Prospective studies are needed to validate these results.

Infectious diseases (London, England). 2018 Oct 29 [Epub ahead of print]

Stamatis Karakonstantis, Dimitra Kalemaki

a 2nd Department of Internal Medicine, General Hospital of Heraklion "Venizeleio-Pananeio" , Heraklion , Greece., b General Medicine, University Hospital of Heraklion , Heraklion , Greece.