Risk for infections after prostate biopsies still rising

In a new article in the Journal of Urology, researchers have found that the risk for post-biopsy infections within 30 days after a prostate biopsy is still rising — potentially because of the continuing increase in prevalence of antibiotic-resistant strains of bacteria.

The new article by Halpern et al. (also discussed in Renal & Urology News) addresses the rates of rates of infection after prostate needle biopsies in New York State between 2011 and 2014, including both transrectal and transperineal biopsies, as reported to the New York Statewide Planning and Research Cooperation System (SPARCS).

Here is the brief summary of the study’s findings:

  • The study was based on data from 9,983 prostate needle biopsies.
    • 9,472 were from transrectal biopsies.
    • 421 were from transperineal biopsies.
  • The commonest indications for biopsy were
    • An elevated PSA level (53.2 percent)
    • Active surveillance (26.7 percent)
    • Abnormal rectal exam (2.6 percent)
    • Atypia on prior biopsy (1.6 percent)
  • Biopsy-associated infection rates increased from 2.6 to 3.5 percent over the study period (p = 0.02).
  • About half of all the infections necessitated at least brief hospitalization.
  • Complications rates were comparable between first biopsies (n = 9,206) and repeat biopsies (n = 777).
  • Rectal swabs prior to biopsy were administered in < 1 percent of cases.
  • On multivariable analysis, several factors were significantly associated with the occurrence of post-biopsy infections, including
    • Patient race
    • Year of biopsy procedure
    • Existing diabetes (odds ratio [OR] = 1.92)
    • Transrectal approach (OR = 3.48)
    • Recent hospitalization (OR = 2.03)

The authors conclude that not only have the New York State-specific rates of post-biopsy infections been increasing, but that

With higher complications using the transrectal approach and minimal utilization of targeted antibiotic prophylaxis, further efforts should focus on the evaluation and implementation of these strategies in order to reduce post-[prostate biopsy] complications nationally.

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