Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Number of risk factors versus infection after transrectal prostate biopsy : a nationwide population-based study

Örtegren, Joakim LU ; Elvstam, Olof LU orcid ; Kohestani, Kimia ; Kjölhede, Henrik LU ; Styrke, Johan ; Stattin, Pär ; Berglund, Anders LU and Bratt, Ola LU (2026) In Scandinavian Journal of Urology 61. p.99-105
Abstract

OBJECTIVE: It is unknown how risk factors for infection after transrectal prostate biopsy interact. We designed a study to evaluate this.

METHODS: We identified biopsy procedures from 2006 to 2020 in the Swedish nationwide database PCBaSe. Primary outcome was post-biopsy infection, defined as a dispensed prescription of a urinary tract antibiotic and secondary outcome was inpatient care for infection both within 30 days. Risk factors were age, diabetes, medical treatment of lower urinary tract symptoms (LUTSs), prostate enlargement, immunosuppressives, corticosteroids, and defined antibiotic exposure during the past 1-12 months. When analysing risk in men with several risk factors clinically related factors were grouped as urinary... (More)

OBJECTIVE: It is unknown how risk factors for infection after transrectal prostate biopsy interact. We designed a study to evaluate this.

METHODS: We identified biopsy procedures from 2006 to 2020 in the Swedish nationwide database PCBaSe. Primary outcome was post-biopsy infection, defined as a dispensed prescription of a urinary tract antibiotic and secondary outcome was inpatient care for infection both within 30 days. Risk factors were age, diabetes, medical treatment of lower urinary tract symptoms (LUTSs), prostate enlargement, immunosuppressives, corticosteroids, and defined antibiotic exposure during the past 1-12 months. When analysing risk in men with several risk factors clinically related factors were grouped as urinary tract infection (UTI)-antibiotics, treatment of LUTS, immunosuppressives including corticosteroids, and diabetes. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CI).

RESULTS: A total of 139,056 transrectal prostate biopsy procedures were analysed. The grouped risk factors were significantly associated with post-biopsy infection (multivariable ORs: 1.22-1.72). Infection increased with number of risk factors; none: 4.0% (95% CI: 3.8-4.1), one: 6% (95% CI: 5.9-6.4), two: 10% (95% CI: 9.3-11), and three or four: 12% (95% CI: 9.8-14); inpatient care increased from 2.0% (95% CI: 1.9-2.1) to 3.1% (95% CI: 2.2-4.4).

CONCLUSION: Infection risk after transrectal prostate biopsy incrementally increases with the number of risk factors.

CLINICAL IMPLICATIONS: The transrectal biopsy route should be used with caution for patients with several risk factors for post-biopsy infections.

PATIENT SUMMARY: Diabetes, urinary symptoms, previous urinary infection, and immune suppressing medication increase the risk of infection after a prostate biopsy through the rectum. Patients with many of these conditions have a particularly high risk. What does the study add? We used nationwide register data to estimate the infection risk after transrectal prostate biopsy by the number of these risk factors: diabetes, medical treatment of lower urinary tract symptoms, immunosuppressives including corticosteroids, and use of urinary tract antibiotics the past year. The risk incrementally increased from 4.0% in men with no risk factor to 12% in those with 3 or 4.

TAKE HOME MESSAGE: Infection after transrectal prostate biopsy increases with number of risk factors: diabetes, medical treatment of lower urinary tract symptoms, immunosuppressives including corticosteroids, and use of urinary tract antibiotics the past year, from 4.0% (none) to 12% (3 or 4).

(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
keywords
Humans, Male, Risk Factors, Aged, Prostate/pathology, Middle Aged, Urinary Tract Infections/etiology, Sweden/epidemiology, Rectum, Postoperative Complications/epidemiology, Biopsy/adverse effects, Anti-Bacterial Agents/therapeutic use, Prostatic Neoplasms/pathology
in
Scandinavian Journal of Urology
volume
61
pages
99 - 105
publisher
Taylor & Francis
external identifiers
  • pmid:41914521
ISSN
2168-1813
DOI
10.2340/sju.v61.45581
language
English
LU publication?
yes
id
42542bae-c71a-41d2-af56-86fe909a7f7a
date added to LUP
2026-03-31 19:27:57
date last changed
2026-04-01 07:29:50
@article{42542bae-c71a-41d2-af56-86fe909a7f7a,
  abstract     = {{<p>OBJECTIVE: It is unknown how risk factors for infection after transrectal prostate biopsy interact. We designed a study to evaluate this.</p><p>METHODS: We identified biopsy procedures from 2006 to 2020 in the Swedish nationwide database PCBaSe. Primary outcome was post-biopsy infection, defined as a dispensed prescription of a urinary tract antibiotic and secondary outcome was inpatient care for infection both within 30 days. Risk factors were age, diabetes, medical treatment of lower urinary tract symptoms (LUTSs), prostate enlargement, immunosuppressives, corticosteroids, and defined antibiotic exposure during the past 1-12 months. When analysing risk in men with several risk factors clinically related factors were grouped as urinary tract infection (UTI)-antibiotics, treatment of LUTS, immunosuppressives including corticosteroids, and diabetes. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CI).</p><p>RESULTS: A total of 139,056 transrectal prostate biopsy procedures were analysed. The grouped risk factors were significantly associated with post-biopsy infection (multivariable ORs: 1.22-1.72). Infection increased with number of risk factors; none: 4.0% (95% CI: 3.8-4.1), one: 6% (95% CI: 5.9-6.4), two: 10% (95% CI: 9.3-11), and three or four: 12% (95% CI: 9.8-14); inpatient care increased from 2.0% (95% CI: 1.9-2.1) to 3.1% (95% CI: 2.2-4.4).</p><p>CONCLUSION: Infection risk after transrectal prostate biopsy incrementally increases with the number of risk factors.</p><p>CLINICAL IMPLICATIONS: The transrectal biopsy route should be used with caution for patients with several risk factors for post-biopsy infections.</p><p>PATIENT SUMMARY: Diabetes, urinary symptoms, previous urinary infection, and immune suppressing medication increase the risk of infection after a prostate biopsy through the rectum. Patients with many of these conditions have a particularly high risk. What does the study add? We used nationwide register data to estimate the infection risk after transrectal prostate biopsy by the number of these risk factors: diabetes, medical treatment of lower urinary tract symptoms, immunosuppressives including corticosteroids, and use of urinary tract antibiotics the past year. The risk incrementally increased from 4.0% in men with no risk factor to 12% in those with 3 or 4.</p><p>TAKE HOME MESSAGE: Infection after transrectal prostate biopsy increases with number of risk factors: diabetes, medical treatment of lower urinary tract symptoms, immunosuppressives including corticosteroids, and use of urinary tract antibiotics the past year, from 4.0% (none) to 12% (3 or 4).</p>}},
  author       = {{Örtegren, Joakim and Elvstam, Olof and Kohestani, Kimia and Kjölhede, Henrik and Styrke, Johan and Stattin, Pär and Berglund, Anders and Bratt, Ola}},
  issn         = {{2168-1813}},
  keywords     = {{Humans; Male; Risk Factors; Aged; Prostate/pathology; Middle Aged; Urinary Tract Infections/etiology; Sweden/epidemiology; Rectum; Postoperative Complications/epidemiology; Biopsy/adverse effects; Anti-Bacterial Agents/therapeutic use; Prostatic Neoplasms/pathology}},
  language     = {{eng}},
  month        = {{03}},
  pages        = {{99--105}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Urology}},
  title        = {{Number of risk factors versus infection after transrectal prostate biopsy : a nationwide population-based study}},
  url          = {{http://dx.doi.org/10.2340/sju.v61.45581}},
  doi          = {{10.2340/sju.v61.45581}},
  volume       = {{61}},
  year         = {{2026}},
}