Better Understanding of Minimizing Infectious Complications After Transrectal Prostate Biopsy

Abstract

The case-control study by Carignan and colleagues helps improve our understanding of risk factors for infection complications after prostate biopsy [1]. The authors noted a significantly increased incidence of infection complications after prostate biopsy, from 0.52 infection per 100 biopsies in 2002–2009 to 2.15 infections per 100 biopsies in 2010–2011. These findings fall in line with trends noted recently by other groups [2,3]. For instance, Loeb et al. reported that risk of infection complications requiring hospitalization was significantly greater in more recent years, when evaluating a 5% random sample of Medicare participants in the United States [2]. In the present study, Carignan and coworkers retrospectively reviewed the charts of 5798 men undergoing transrectal prostate biopsy between 2002 and 2011. From this cohort, the investigators identified 48 men who developed urinary sepsis after biopsy. These 48 patients were randomly matched to 192 control patients who underwent prostate biopsy without infectious complications. Using this approach, the authors identified, on multivariate analysis, diabetes mellitus, hospitalization in the month before biopsy, chronic obstructive pulmonary disease, and later calendar year of biopsy as risk factors for postbiopsy infection [1]. The authors found that Escherichia coli was the most common pathogen (75% of cases) and the cultured pathogen was resistant to ciprofloxacin in 52% of cases. The study follows other reports that, collectively, have identified later calendar year of biopsy, nonwhite race, higher comorbidity scores, enlarged prostate, recent international travel, and recent antibiotic use as risk factors for postbiopsy infection [1–5]. The increasinglycommonproblemofpostbiopsy infection is particularly vexing since transrectal ultrasound-guided