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Increasing rates of urinary- and bloodstream infections following transrectal prostate biopsy in South Sweden

Ljungquist, Oskar LU ; Persmark, Ale LU ; Grabe, Magnus LU ; Krag Jakobsen, Ane LU ; Gerdtsson, Axel LU ; Torisson, Gustav LU orcid ; Bjartell, Anders LU and Riesbeck, Kristian LU orcid (2022) In BJU International 130(4). p.478-485
Abstract
Objective
To report trends and characteristics of post-biopsy infections, with regard to etiology and resistance patterns, in a large unique cohort from a single-centre using the same antibiotic prophylactic regimens during a 15-year period.

Methods
This is an observational cross sectional cohort study, including all patients who underwent transrectal prostate biopsy (TR PBx) guided by ultrasound for the suspicion of prostate cancer at the Department of Urology, Skåne University Hospital between 1st May 2003 and 31st December 2017. Positive blood and urinary cultures were considered markers of bloodstream infection (BSI) and urinary tract infection (UTI), respectively. For all patients, details regarding blood or urine... (More)
Objective
To report trends and characteristics of post-biopsy infections, with regard to etiology and resistance patterns, in a large unique cohort from a single-centre using the same antibiotic prophylactic regimens during a 15-year period.

Methods
This is an observational cross sectional cohort study, including all patients who underwent transrectal prostate biopsy (TR PBx) guided by ultrasound for the suspicion of prostate cancer at the Department of Urology, Skåne University Hospital between 1st May 2003 and 31st December 2017. Positive blood and urinary cultures were considered markers of bloodstream infection (BSI) and urinary tract infection (UTI), respectively. For all patients, details regarding blood or urine cultures from the date of the prostate biopsy and 14 days onwards were retrieved.

Results
In total, 8,973 transrectal biopsy procedures were performed in 6,597 men during the study period. Over time, there was a trend towards a changing case-mix, with biopsy procedures increasingly being performed in older patients, patients with lower PSA values and higher prostate volume. During the study period, the number of biopsy procedures performed increased for each time period and we found an increasing rate of infectious complications in the last period. Overall, the rates of BSI and UTI with at least one relevant pathogen were 1 % (88/8,973) and 1.8% (159/8,973), respectively. In total, 16 of 90 strains (18%) were ESBL-producing, with an increasing proportion over time. The proportion of ciprofloxacin-resistant pathogens did not increase over time.

Conclusion
During the 15 years of this study, BSI and UTI after TR PBx increased. The rise of infectious complications post TR PBx in this population is unlikely to be explained by quinolone-resistance, as ciprofloxacin-resistance did not increase in the blood and urinary samples obtained during the study period. Future longitudinal studies are warranted to investigate why infectious complications after TR PBx are increasing. (Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BJU International
volume
130
issue
4
pages
478 - 485
publisher
Wiley-Blackwell
external identifiers
  • scopus:85125842258
  • pmid:35174613
ISSN
1464-4096
DOI
10.1111/bju.15713
language
English
LU publication?
yes
id
119ccd0a-62b2-40d8-b7b1-95fea1236b73
date added to LUP
2022-02-17 12:26:48
date last changed
2022-10-31 14:58:01
@article{119ccd0a-62b2-40d8-b7b1-95fea1236b73,
  abstract     = {{Objective<br/>To report trends and characteristics of post-biopsy infections, with regard to etiology and resistance patterns, in a large unique cohort from a single-centre using the same antibiotic prophylactic regimens during a 15-year period.<br/><br/>Methods<br/>This is an observational cross sectional cohort study, including all patients who underwent transrectal prostate biopsy (TR PBx) guided by ultrasound for the suspicion of prostate cancer at the Department of Urology, Skåne University Hospital between 1st May 2003 and 31st December 2017. Positive blood and urinary cultures were considered markers of bloodstream infection (BSI) and urinary tract infection (UTI), respectively. For all patients, details regarding blood or urine cultures from the date of the prostate biopsy and 14 days onwards were retrieved.<br/><br/>Results<br/>In total, 8,973 transrectal biopsy procedures were performed in 6,597 men during the study period. Over time, there was a trend towards a changing case-mix, with biopsy procedures increasingly being performed in older patients, patients with lower PSA values and higher prostate volume. During the study period, the number of biopsy procedures performed increased for each time period and we found an increasing rate of infectious complications in the last period. Overall, the rates of BSI and UTI with at least one relevant pathogen were 1 % (88/8,973) and 1.8% (159/8,973), respectively. In total, 16 of 90 strains (18%) were ESBL-producing, with an increasing proportion over time. The proportion of ciprofloxacin-resistant pathogens did not increase over time.<br/><br/>Conclusion<br/>During the 15 years of this study, BSI and UTI after TR PBx increased. The rise of infectious complications post TR PBx in this population is unlikely to be explained by quinolone-resistance, as ciprofloxacin-resistance did not increase in the blood and urinary samples obtained during the study period. Future longitudinal studies are warranted to investigate why infectious complications after TR PBx are increasing.}},
  author       = {{Ljungquist, Oskar and Persmark, Ale and Grabe, Magnus and Krag Jakobsen, Ane and Gerdtsson, Axel and Torisson, Gustav and Bjartell, Anders and Riesbeck, Kristian}},
  issn         = {{1464-4096}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{478--485}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{BJU International}},
  title        = {{Increasing rates of urinary- and bloodstream infections following transrectal prostate biopsy in South Sweden}},
  url          = {{http://dx.doi.org/10.1111/bju.15713}},
  doi          = {{10.1111/bju.15713}},
  volume       = {{130}},
  year         = {{2022}},
}