P 01. Changes in trends of cultures from post TR biopsy prostatitis in the past decade

Introduction and objective: Transrectal ultrasound guided needle biopsy of the prostate is the gold standard to confirm diagnosis of prostate cancer in suspicious patients. The most concerning complication in this widely utilized procedure is bacterial sepsis. The reported incidence of bacteremia after prostate biopsy ranges from 16% to 73%. Despite antibiotic prophylaxis before procedure being a general recommendation, several recent studies have reported significant increase of infection related complications. The present study reviews 10 years of transrectal prostate biopsies to present the trends in culture positive post procedure infections.

Methods: A retrospective review of patients who received transrectal prostate biopsy at a single referral hospital from January 2002 to July 2011 was performed. Patient characteristics, past history of underlying diseases and previous recent antibiotic use, procedure related factors, clinical factors and laboratory factors were included in the analysis. All patients received urine and serum culture, and all cultures were also characterized based on their extended spectrum beta-lactamase (ESBL) activity.

Results: A total of 3657 patients received trans rectal prostate biopsy during the past decade. Of these patients 27 (0.73%) reported clinical symptoms of prostatitis within 30 days after the procedure; all 27 were admitted. The average age of the patients was 66.7 year (range, 51 to 79). Seventeen of the 27 patients (62.9%) were found to have positive cultures from the urine or serum. E.coli was the most frequently cultured organism (15/17; 88.2%), followed by Klebsiella and Acinetobacter baumanni (both 1/17; 5.8%). Nine cases showed resistance to ESBL (52.9%) and 4 cases showed quinolone resistance (28.6%). In particular, patients with ESBL resistant cultures showed a significantly more febrile clinical course; the patients had higher peak fever, longer duration of fever, longer hospitalization and higher neutrophil percentage in leukocytosis (P<0.05). Furthermore a significantly higher proportion of ESBL resistant patients reported of using antibiotics within 3 months prior to the procedure (77.8% vs. 50%), though this was not statistically significant (P=0.231).

Conclusions: Analysis of prostate biopsies performed during the past decade suggests significant morbidity of patients with infections from ESBL resistant strains. These patients may be associated with recent antibiotic use. Control and management of clinical antibiotic prescriptions before biopsy may be indicated.