Research reports suggest that the rate of infectious complications, including sepsis, after transrectal prostate needle biopsy may be increasing. Recently published news articles highlighted these findings, and it is important for urologists to be aware of this issue.
According to the AUA Best Practice Statement on Urologic Surgery Antimicrobial Prophylaxis, the antimicrobial of choice prior to prostate needle biopsy is a fluoroquinolone or a second- or third-generation cephalosporin. Alternative agents include an aminoglycoside plus metronidazole or clindamycin. Oral fluoroquinolones are the most commonly used agents in clinical practice.
The primary reason for post-biopsy infections appears to be the presence of fluoroquinolone-resistant organisms in the fecal flora. Risk factors which predict the presence of resistant bacteria are not well defined, but may include previous fluoroquinolone administration, and patient occupation as a healthcare worker. Prior to performing a transrectal prostate biopsy, urologists should consider broadening the antimicrobial coverage in patients with these risk factors. Furthermore, in men with signs of an infection after prostate needle biopsy, the presence of resistant bacteria is likely and broad-spectrum treatment should be initiated.
The AUA Best Practice Policy Statement on Urologic Surgery Antimicrobial Prophylaxis, with full references, is available online here.
Wendy Waldsachs Isett, AUA