San Diego, CA USA (UroToday.com): Dr. Declan Murphy, MD addresses the importance of preventing prostate biopsy infection. TRUS biopsy infection is a significant problem. Multiple studies suggest that the infectious complications post-TRUS prostate bipsy are increasing. This is also a result of over-prescribing antibiotics. Additionally, antibiotic prophylaxis is also used in food production chains. Dr. Murphy addresses that ciprofloxacin is commonly used.
Flouroquinolone resistance exists in up to 20.5% of patients who undergo rectal swab cultures. These cultures additionally increase the likelihood of infection by four fold (Liss et al, J Urol 2014). Rectal cleansing has not been shown to reduce rates of these infections. Augmented antibiotics beyond fluroquinolone is needed.
MUSIC initiative addressed the prostate-biopsy infection by promoting augmented antibiotics and rectal swab-related prophylaxis. The results showed a 53% reduction in hospitalizations related to infections at the expense of 89% increased rates of augmented prophylaxis.
AUA 2016 guidelines on prostate biopsy suggested the following to reduce infections:
- Risk assessment for fluoroquinolone resistance (travel to south-east asia)
- Fluoroquinolone prophylaxis for < 24 hours
- Check local antiobiograms for fluoroquinolone resistance
- Check equipment and sterilization
- Consider stopping anticoagulation
- Evaluate and treat infections promptly.
Risk factors for infections include diabetes, immunosuppression, history of UTI, previous prostate biopsy infection, antibiotics use in past 6 months, recent international travel (especially South-East Asia), and colonization with fluoroquinolone-resistant E. Coli.
Dr. Murphy then showed data illustrating that transperineal biopsy is safe and has a low incidence of post-biopsy infection. It is more commonly done under general anesthesia. However, various companies are trying to bring the transperineal biopsy into office practice.
Dr. Murphy concludes that TRUS-guided prostate biopsy is associated with increasing infectious complications. 2016 AUA guidelines identify some strategies to reduce risks. In those with high-risk, we may need to consider rectal swab or a transperineal approach.
Presented By: Declan Murphy, MD