Skip to main content

Advertisement

SpringerLink
Log in

Enhanced antibiotic prophylaxis and infection-related complications following prostate biopsy

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Sepsis after prostate biopsy is a costly and potentially lethal complication. We sought to assess whether enhanced antibiotic prophylaxis regimens combining oral and parenteral antibiotics may decrease the risk of post-biopsy urinary tract infection and sepsis compared to regimens with only oral antibiotics.

Methods

We identified men with commercial insurance who underwent prostate biopsy (2009–2015) with prophylactic antibiotic coverage. Our primary exposure of interest was antibiotic regimen: enhanced, oral-only, and parenteral-only. Post-biopsy outcomes of interest included urinary tract infections and sepsis/bacteremia after prostate biopsy. We used bivariate testing to assess associations between outcomes, exposures, and other covariates of interest. Multivariable regression was used to estimate adjusted odds of infectious outcomes based on antibiotic regimen.

Results

We identified 163,831 men who underwent prostate biopsy. The proportion of men with infectious complications (5.5% in 2009 to 6.9% in 2015, p < 0.001) and sepsis (0.24% in 2009 to 0.30% in 2015, p = 0.327) increased over the timeframe of our analysis. Use of fluoroquinolones was associated with a decreased risk of infectious outcomes (5.8 vs 7.3% without, OR 0.83, 95% CI 0.79–0.88). Use of enhanced antibiotic regimens was associated with an increased risk of infectious outcomes (6.8 vs 5.7% oral, OR 1.23, 95% CI 1.16–1.31) and sepsis (0.34 vs 0.24% oral, OR 1.40, 95% CI 1.08–1.82) among our cohort.

Conclusion

We did not observe a significant reduction in infectious complications among men who received enhanced antibiotics regimens before prostate biopsy. This may be due to increased antibiotic resistance or unmeasured risk factors among those receiving enhanced regimens.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Not applicable.

Code availability

Not applicable.

References

  1. Roberts MJ, Bennett HY, Harris PN, Holmes M, Grummet J, Naber K, Wagenlehner FME (2017) Prostate biopsy-related infection: a systematic review of risk factors, prevention strategies, and management approaches. Urology 104:11–21. https://doi.org/10.1016/j.urology.2016.12.011

    Article  PubMed  Google Scholar 

  2. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM (2011) Complications after prostate biopsy: data from SEER-medicare. J Urol 186(5):1830–1834. https://doi.org/10.1016/j.juro.2011.06.057

    Article  PubMed  Google Scholar 

  3. Jiang P, Liss MA, Szabo RJ (2018) Targeted antimicrobial prophylaxis does not always prevent sepsis after transrectal prostate biopsy. J Urol 200(2):361–368. https://doi.org/10.1016/j.juro.2018.03.078

    Article  PubMed  Google Scholar 

  4. Cheung C, Patel HD, Landis P, Carter HB, Han M (2018) Targeted antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy during active surveillance: effect on hospitalization. Urol Oncol 36(4):158.e7-158.e12. https://doi.org/10.1016/j.urolonc.2017.12.005

    Article  Google Scholar 

  5. Gross MD, Alshak MN, Shoag JE, Laviana AA, Gorin MA, Sedrakyan A, Hu JC (2019) Healthcare costs of post-prostate biopsy sepsis. Urology 133:11–15. https://doi.org/10.1016/j.urology.2019.06.011

    Article  PubMed  Google Scholar 

  6. Evans R, Loeb A, Kaye KS, Cher ML, Martin ET (2017) Infection-related hospital admissions after prostate biopsy in United States men. Open Forum Infect Dis 4(1):ofw265. https://doi.org/10.1093/ofid/ofw265

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lightner DJ, Wymer K, Sanchez J, Kavoussi L (2020) Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol 203(2):351–356. https://doi.org/10.1097/JU.0000000000000509

    Article  PubMed  Google Scholar 

  8. Bonkat G, Pilatz A, Wagenlehner F (2019) Time to adapt our practice? The European Commission has restricted the use of fluoroquinolones since March 2019. Eur Urol 76(3):273–275. https://doi.org/10.1016/j.eururo.2019.06.011

    Article  PubMed  Google Scholar 

  9. European Medicines Agency (2019) Quinolone- and fluoroquinolone-containing medicinal products. Published November 3, 2019. Available at: https://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products

  10. Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, Fanti S, Fossati N, Gandaglia G, Gillessen S, Grivas N, Grummet J, Henry AM, van der Kwast TH, Lam TB, Lardas M, Liew M, Mason MD, Moris L, Oprea-Lager DE, van der Poel HG, Rouviere O, Schoots IG, Tilki D, Wiegel T, Willemse PM, Cornford P (2020) EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. https://doi.org/10.1016/j.eururo.2020.09.042

    Article  PubMed  PubMed Central  Google Scholar 

  11. Toner L, Bolton DM, Lawrentschuk N (2016) Prevention of sepsis prior to prostate biopsy. Investig Clin Urol 57(2):94–99. https://doi.org/10.4111/icu.2016.57.2.94

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ho HS, Ng LG, Tan YH, Yeo M, Cheng CW (2009) Intramuscular gentamicin improves the efficacy of ciprofloxacin as an antibiotic prophylaxis for transrectal prostate biopsy. Ann Acad Med Singap 38(3):212–216

    PubMed  Google Scholar 

  13. Womble PR, Dixon MW, Linsell SM, Ye Z, Montie JE, Lane BR, Miller DC, Burks FN, Michigan Urological Surgery Improvement Collaborative (2014) Infection related hospitalizations after prostate biopsy in a statewide quality improvement collaborative. J Urol 191(6):1787–1792. https://doi.org/10.1016/j.juro.2013.12.026

    Article  PubMed  Google Scholar 

  14. Adibi M, Hornberger B, Bhat D, Raj G, Roehrborn CG, Lotan Y (2013) Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic prophylaxis. J Urol 189(2):535–540. https://doi.org/10.1016/j.juro.2012.08.194

    Article  PubMed  Google Scholar 

  15. Bittoni MA, Wexler R, Spees CK, Clinton SK, Taylor CA (2015) Lack of private health insurance is associated with higher mortality from cancer and other chronic diseases, poor diet quality, and inflammatory biomarkers in the United States. Prev Med 81:420–426. https://doi.org/10.1016/j.ypmed.2015.09.016

    Article  PubMed  Google Scholar 

  16. Taylor AK, Zembower TR, Nadler RB, Scheetz MH, Cashy JP, Bowen D, Murphy AB, Dielubanza E, Schaeffer AJ (2012) Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol 187(4):1275–1279. https://doi.org/10.1016/j.juro.2011.11.115

    Article  CAS  PubMed  Google Scholar 

  17. Hadjipavlou M, Eragat M, Kenny C, Pantelidou M, Mulhem W, Wood C, Dall’Antonia M, Hammadeh MY (2020) Effect of augmented antimicrobial prophylaxis and rectal swab culture-guided targeted prophylaxis on the risk of sepsis following transrectal prostate biopsy. Eur Urol Focus 6(1):95–101. https://doi.org/10.1016/j.euf.2018.06.016

    Article  PubMed  Google Scholar 

  18. Gomella LG (2018) Should urology reconsider the routine use of fluoroquinolones? Can J Urol 25(4):9366

    PubMed  Google Scholar 

  19. United States Food and Drug Administration (2016) FDA drug safety communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. Published July 26, 2016. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics

  20. Pilatz A, Veeratterapillay R, Dimitropoulos K, Omar MI, Pradere B, Yuan Y, Cai T, Mezei T, Devlies W, Bruyere F, Bartoletti R, Koves B, Geerlings S, Schubert S, Grummet J, Mottet N, Wagenlehner F, Bonkat G (2021) European Association of Urology position paper on the prevention of infectious complications following prostate biopsy. Eur Urol 79(1):11–15. https://doi.org/10.1016/j.eururo.2020.10.019

    Article  PubMed  Google Scholar 

  21. Pilatz A, Dimitropoulos K, Veeratterapillay R, Yuan Y, Omar MI, MacLennan S, Cai T, Bruyere F, Bartoletti R, Koves B, Wagenlehner F, Bonkat G, Pradere B (2020) Antibiotic prophylaxis for the prevention of infectious complications following prostate biopsy: a systematic review and meta-analysis. J Urol 204(2):224–230. https://doi.org/10.1097/JU.0000000000000814

    Article  PubMed  Google Scholar 

  22. Yang L, Tang Z, Gao L, Li T, Chen Y, Liu L, Han P, Li X, Dong Q, Wei Q (2016) The augmented prophylactic antibiotic could be more efficacious in patients undergoing transrectal prostate biopsy: a systematic review and meta-analysis. Int Urol Nephrol 48(8):1197–1207. https://doi.org/10.1007/s11255-016-1299-7

    Article  CAS  PubMed  Google Scholar 

  23. Yang L, Gao L, Chen Y, Tang Z, Liu L, Han P, Zeng H, Li X, Wei Q (2015) Prophylactic antibiotics in prostate biopsy: a meta-analysis based on randomized controlled trials. Surg Infect (Larchmt) 16(6):733–747. https://doi.org/10.1089/sur.2015.040

    Article  Google Scholar 

  24. Jones TA, Radtke JP, Hadaschik B, Marks LS (2016) Optimizing safety and accuracy of prostate biopsy. Curr Opin Urol 26(5):472–480. https://doi.org/10.1097/MOU.0000000000000310

    Article  PubMed  PubMed Central  Google Scholar 

  25. Bennett HY, Roberts MJ, Doi SA, Gardiner RA (2016) The global burden of major infectious complications following prostate biopsy. Epidemiol Infect 144(8):1784–1791. https://doi.org/10.1017/S0950268815002885

    Article  CAS  PubMed  Google Scholar 

  26. Leung AK, Patil D, Howard DH, Filson CP (2020) Payments and patient cost sharing for prostate biopsies according to image guidance practice site and use of anesthesia. Urol Pract 7(2):138–144. https://doi.org/10.1097/UPJ.0000000000000073

    Article  Google Scholar 

  27. Bhanji Y, Allaway MJ, Gorin MA (2021) Recent advances and current role of transperineal prostate biopsy. Urol Clin North Am 48(1):25–33. https://doi.org/10.1016/j.ucl.2020.09.010

    Article  PubMed  Google Scholar 

  28. Szabo RJ (2020) “Free-Hand” transperineal prostate biopsy under local anesthesia: review of the literature. J Endourol. https://doi.org/10.1089/end.2020.1093

    Article  Google Scholar 

  29. Stefanova V, Buckley R, Flax S, Spevack L, Hajek D, Tunis A, Lai E, Loblaw A (2019) Transperineal prostate biopsies using local anesthesia: experience with 1287 patients. Prostate cancer detection rate, complications and patient tolerability. J Urol 201(6):1121–1126. https://doi.org/10.1097/JU.0000000000000156

    Article  PubMed  Google Scholar 

  30. Exterkate L, Wegelin O, Barentsz JO, van der Leest MG, Kummer JA, Vreuls W, de Bruin PC, Bosch J, van Melick HHE, Somford DM (2020) Is there still a need for repeated systematic biopsies in patients with previous negative biopsies in the era of magnetic resonance imaging-targeted biopsies of the prostate? Eur Urol Oncol 3(2):216–223. https://doi.org/10.1016/j.euo.2019.06.005

    Article  PubMed  Google Scholar 

  31. Tamhankar AS, El-Taji O, Vasdev N, Foley C, Popert R, Adshead J (2020) The clinical and financial implications of a decade of prostate biopsies in the NHS: analysis of hospital episode statistics data 2008–2019. BJU Int 126(1):133–141. https://doi.org/10.1111/bju.15062

    Article  PubMed  Google Scholar 

  32. Patient Centered Outcomes Research Institute (2020) Randomized trial comparing transperineal vs. transrectal MRI-targeted prostate biopsy. Published April 16, 2020. Available at: https://www.pcori.org/research-results/2020/randomized-trial-comparing-transperineal-vs-transrectal-mri-targeted-prostate

  33. van der Leest M, Cornel E, Israel B, Hendriks R, Padhani AR, Hoogenboom M, Zamecnik P, Bakker D, Setiasti AY, Veltman J, van den Hout H, van der Lelij H, van Oort I, Klaver S, Debruyne F, Sedelaar M, Hannink G, Rovers M, Hulsbergen-van de Kaa C, Barentsz JO (2019) Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naive men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol 75(4):570–578. https://doi.org/10.1016/j.eururo.2018.11.023

    Article  PubMed  Google Scholar 

  34. Awasthi S, Gerke T, Williams VL, Asamoah F, Fink AK, Balkrishnan R, Park JY, Yamoah K (2019) Interrelationship between health insurance status and prostate cancer grade can have critical impact on prostate cancer disease control: a retrospective cohort study. Cancer Control 26(1):1073274819837184. https://doi.org/10.1177/1073274819837184

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported in part with salary support from a grant from the American Cancer Society for CPF (MRSG-18-1-CPHPS) and the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378 and TL1TR002382 for RSS.

Author information

Authors and Affiliations

  1. Department of Urology, Emory University School of Medicine, Atlanta, GA, USA

    Rebecca S. Steinberg, K. C. Biebighauser Bens, Dattatraya Patil, Mark Henry, Akanksha Mehta & Christopher Filson

  2. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Lauren Kipling

  3. Winship Cancer Institute, Emory Healthcare, Atlanta, GA, USA

    Christopher Filson

Authors
  1. Rebecca S. Steinberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren Kipling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. C. Biebighauser Bens
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dattatraya Patil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akanksha Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christopher Filson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RSS: manuscript writing/editing, data analysis, data collection and management; LK: data analysis, data collection or management; KCBB: data collection or management; DP: protocol/project development, data analysis, data collection or management; MH: data collection or management; AM: data collection or management; CF: protocol/project development, manuscript writing/editing, data analysis, data collection and management

Corresponding author

Correspondence to Christopher Filson.

Ethics declarations

Conflict of interest

Not applicable.

Ethics approval

This analysis was deemed exempt from IRB oversight with its use of de-identifed data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 62 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Steinberg, R.S., Kipling, L., Bens, K.C.B. et al. Enhanced antibiotic prophylaxis and infection-related complications following prostate biopsy. World J Urol 39, 3415–3422 (2021). https://doi.org/10.1007/s00345-021-03674-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-021-03674-w

Keywords

Search

Navigation