Abstract
Purpose
To determine the rate of hospital admissions for infection after transperineal biopsy of prostate (TPB) with single-dose cephazolin prophylaxis using a prospective database.
Method
Between April 2013 and February 2016, 577 patients undergoing TPB had 2 g of cephazolin given intravenously at induction of anaesthesia. Data collected from these patients included age, PSA, prostate volume, number of cores taken and post-operative complications.
Results
No patients were readmitted to hospital with infection post-TPB. Seven patients developed acute urinary retention, and one patient developed clinical prostatitis that was treated with oral antibiotics in the community.
Conclusion
It is safe to use single-dose cephazolin only as antibiotic prophylaxis prior to TPB, negating the need for quinolones. This study supports Australia’s current Therapeutic Guidelines recommendation for TPB prophylaxis and the existing evidence that sepsis post-TPB is a rare complication. Whether any antibiotic prophylaxis is needed at all for TPB is the subject of a future study.
Similar content being viewed by others
References
Loeb S, Carter HB, Berndt SI et al (2011) Complications after prostate biopsy: data from SEER-medicare. J Urol 186(5):1830–1834
Davis P, Paul E, Grummet J (2015) Current practice of prostate biopsy in Australia and New Zealand: a survey. Urol Ann 7(3):315–319
Galfano A, Novara G, Iafrate M et al (2007) Prostate biopsy: the transperineal approach. http://eu-acme.org/europeanurology/upload_articles/Prostate%20Biopsy_The%20Transperineal%20Approach.pdf
Mottet N, Bellmunt J, Briers E et al (2015) Guidelines on prostate cancer. http://uroweb.org/wp-content/uploads/09-Prostate-Cancer_LRV2-2015.pdf
El-Hakim A, Moussa S (2010) CUA guidelines on prostate biopsy methodology. Can Urol Assoc J 4(2):89–94
Nam RK, Saskin R, Lee Y et al (2013) Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 189(1 Suppl):S12–S17 (discussion S17–S18)
Wagenlehner FM, van Oostrum E, Tenke P et al (2013) Infective complications after prostate biopsy: outcome of the global prevalence study of infections in urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Eur Urol 63(3):521–527
Zaytoun OM, Vargo EH, Rajan R et al (2011) Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment. Urology 77(5):1035–1041
Grummet JP, Weerakoon M, Huang S et al (2014) Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy? BJU Int 114(3):384–388
Vyas L, Acher P, Kinsella J et al (2014) Indications, results and safety profile of transperineal sector biopsies (TPSB) of the prostate: a single centre experience of 634 cases. BJU Int 114(1):32–37
Pepe P, Aragona F (2013) Morbidity after transperineal prostate biopsy in 3000 patients undergoing 12 vs 18 vs more than 24 needle cores. Urology 81(6):1142–1146
Suzuki M, Kawakami S, Asano T et al (2009) Safety of transperineal 14-core systematic prostate biopsy in diabetic men. Int J Urol 16(12):930–935
Transperineal prostatic biopsy (2015) Therapeutic guidelines. http://online.tg.org.au/ip/desktop/index.htm
Wolf JS Jr, Bennett CJ, Dmochowski RR et al (2008) Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol 179(4):1379–1390
Lee G, Attar K, Laniado M et al (2007) Trans-rectal ultrasound guided biopsy of the prostate: nationwide diversity in practice and training in the United Kingdom. Int Urol Nephrol 39(1):185–188
Raaijmakers R, Kirkels WJ, Roobol MJ et al (2002) Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology 60(5):826–830
Drew RJ, Turton JF, Hill RL et al (2013) Emergence of carbapenem-resistant enterobacteriaceae in a UK paediatric hospital. J Hosp Infect 84(4):300–304
Kotsanas D, Wijesooriya WR, Korman TM et al (2013) “Down the drain”: carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks. Med J Aust 198(5):267–269
Cuevas O, Oteo J, Lazaro E et al (2011) Significant ecological impact on the progression of fluoroquinolone resistance in Escherichia coli with increased community use of moxifloxacin, levofloxacin and amoxicillin/clavulanic acid. J Antimicrob Chemother 66(3):664–669
Taylor S, Margolick J, Abughosh Z et al (2013) Ciprofloxacin resistance in the faecal carriage of patients undergoing transrectal ultrasound guided prostate biopsy. BJU Int 111(6):946–953
Leahy OR, O’Reilly M, Dyer DR et al (2014) Transrectal ultrasound-guided biopsy sepsis and the rise in carbapenem antibiotic use. ANZ J Surg. doi:10.1111/ans.12933
Borer A, Gilad J, Sikuler E et al (1999) Fatal Clostridium sordellii ischio-rectal abscess with septicaemia complicating ultrasound-guided transrectal prostate biopsy. J Infect 38(2):128–129
Brewster SF, Rooney N, Kabala J et al (1993) Fatal anaerobic infection following transrectal biopsy of a rare prostatic tumor. Br J Urol 72(6):977–978
Grabe M, Bartoletti R, Bjerklund-Johansen TE et al (2015) Guidelines on urological infections. http://uroweb.org/wp-content/uploads/19-Urological-infections_LR.pdf
Acknowledgements
Funding was provided by Ipsen.
Authors’ contributions
LP and GT were involved in the data management, data analysis and manuscript writing/editing; SH and SM were involved in the data management; MF, DM, UH, AL and RS were involved in the data collection; JG was involved in the protocol development and manuscript writing/editing.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Pepdjonovic, L., Tan, G.H., Huang, S. et al. Zero hospital admissions for infection after 577 transperineal prostate biopsies using single-dose cephazolin prophylaxis. World J Urol 35, 1199–1203 (2017). https://doi.org/10.1007/s00345-016-1985-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-016-1985-1