Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis?

Eur Urol. 2012 Sep;62(3):453-9. doi: 10.1016/j.eururo.2012.04.044. Epub 2012 May 3.


Background: An increasing risk of infectious complications following transrectal ultrasound-guided prostate needle biopsy (PNB) has been observed recently in some centers.

Objective: To delineate the risk factors associated with post-PNB bacteremia and/or urinary tract infection (UTI) and determine why this risk has risen over time.

Design, setting, and participants: A case-control study in a Canadian tertiary-care center. Cases were all patients who developed bacteremia and/or UTIs after PNB between 2002 and 2011; controls were randomly selected among patients who underwent a PNB without such complications.

Outcome measurements and statistical analysis: Crude and adjusted odds ratios and their 95% confidence intervals were calculated using logistic regression.

Results and limitations: A total of 5798 PNBs were performed during the study period, following which there were 48 cases of urinary sepsis (42% with bacteremia). The incidence increased from 0.52 infections per 100 biopsies in 2002-2009 to 2.15 infections per 100 biopsies in 2010-2011 (p<0.001). Escherichia coli was the predominant pathogen (75% of cases). Among 42 patients whose post-PNB infection was caused by aerobic or facultative Gram-negative rods, 22 patients (52%) were infected by pathogens resistant to ciprofloxacin. Independent risk factors for post-PNB infection were diabetes, hospitalization during the preceding month, chronic obstructive pulmonary disease, and performance of the biopsy in 2010-2011. In 2010-2011, the minimal inhibitory concentrations for ciprofloxacin increased compared with 2002-2009 (p<0.03). The major limitation of the study was its retrospective hospital-based nature, which hampered data collection on outpatient antibiotic prescriptions.

Conclusions: In the past 2 yr, ciprofloxacin resistance contributed to the increasing incidence of post-PNB infections in our center. Novel antibacterial prophylaxis approaches need to be evaluated.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Antibiotic Prophylaxis*
  • Biopsy, Needle / adverse effects
  • Chi-Square Distribution
  • Ciprofloxacin / administration & dosage
  • Drug Resistance, Bacterial
  • Humans
  • Image-Guided Biopsy / adverse effects*
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Predictive Value of Tests
  • Prostate / pathology*
  • Prostatic Neoplasms / pathology*
  • Quebec / epidemiology
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sepsis / diagnosis
  • Sepsis / epidemiology
  • Sepsis / microbiology
  • Sepsis / prevention & control*
  • Tertiary Care Centers
  • Time Factors
  • Ultrasonography, Interventional / adverse effects*
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / microbiology
  • Urinary Tract Infections / prevention & control*


  • Anti-Bacterial Agents
  • Ciprofloxacin