Comment on: The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention

Abstract

Transrectal ultrasound-guided needle biopsies (TGBs) are the mainstayof prostate cancer diagnosis. An averageof 72500 TGBs were performed in England and Wales in 2008. Current guidelines recommend fluoroquinoloneprophylaxis for TGBs. However, emerging fluoroquinolone resistance has led to increased frequency and mor-bidity due to post-TGB infections. Following TGB, 2.15%–3.6% of patients are readmitted with infective com-plications. We estimate readmissions result in 25745–37062 bed days at an annual cost of £7.7–11.1million in England and Wales. Clearly, an increase in post-TGB infections with resistant organisms has a pro-found clinical and economic impact. We suggest alternative approaches to prophylaxis to reduce post-TGBinfections. These include prophylaxis based on local antibiotic resistance surveillance and targeted prophylaxisbased on antibiograms of coliforms detected in pre-biopsy rectal swabs. Other strategies include selective pros-tate-specific antigen (PSA) screening and the use of biomarkers like prostate cancer antigen 3 (PCA3) to reducethe number of TGBs. Furthermore, transperineal biopsy has been shown to be associated with fewer infections.Keywords: prostate cancer, healthcare-associated infections, healthcare costs, ciprofloxacin resistance, antimicrobial prophylaxis,harm limitation