Temporal trends of infectious complications following transrectal ultrasound-guided prostate biopsy at a Canadian tertiary cancer center
Background: Antimicrobial prophylaxis prior to transrectal ultrasound (TRUS)-guided prostate biopsy reduces the risk of infectious complications. Despite increasing E. coli resistance to fluoroquinolones, oral ciprofloxacin remains the most widely used agent for this indication. We reviewed the temporal trends of infection-related complications following TRUS-guided prostate biopsy at Princess Margaret Cancer Center, a Canadian tertiary care hospital where ciprofloxacin prophylaxis is used.
Methods: Surveillance for complications following TRUS-guided prostate biopsy at our center has been conducted since 2003. Complications that occurred within 30-days of the procedure were included. Definite infections were defined as either a positive blood or urine culture in a patient meeting National Healthcare Safety Network (NHSN) criteria for bloodstream or urinary tract infection, respectively. Possible infections were defined as empiric treatment for cystitis, pyelonephritis, prostatitis, epididymo-orchitis, or sepsis without culture confirmation.
Results: Of 19279 men who underwent TRUS-guided prostate biopsy between 2003 and 2013, 159 (0.8%) developed infectious complications. Between 2006 and 2013, definite urinary tract infection increased from 0.05% to 0.8% (p<.0001); bloodstream infections increased from 0.1% to 0.6% (p<0.0001); and overall infections, including definite and possible infections, increased from 0.3% to 1.9% (p<.0001) (Figure). E. coli represented (85/89) 95% of isolates from urine and blood cultures of which 93% were resistant to ciprofloxacin. Resistance of E. coli to trimethoprim/sulfamethoxazole, gentamicin, cefazolin, ceftriaxone, and nitrofurantoin was 58%, 42%, 33%, 32%, and 8%, respectively.
Conclusion: The proportion of TRUS-guided prostate biopsies associated with infectious complications has increased significantly over the past decade, likely driven by the emergence of E. coli resistance to ciprofloxacin. Emerging antibiotic resistance may make current prophylaxis strategies with ciprofloxacin less effective, emphasizing the need for prospective evaluation of other prophylactic regimens and other non-antibiotic prevention strategies.
W. Gold, None
A. Mcgeer, None
A. Toi, None