A retrospective study of patients with post-TRPB (transrectal prostate biopsy) bacteraemia

Abstract

Background Transrectal ultrasound-guided needle biopsy of the prostate is a standard procedure to investigate patients with elevated serum prostate-specific antigen or abnormal findings on a digital rectal examination. Antibiotic prophylaxis is prescribed before the procedure to reduce the infective complication. Yet, a minority of patients still suffered from bacteraemia afterwards. “Big gums” antibiotics are commonly prescribed under such situation, but there is no universal recommendation on the appropriate choice of antibiotics for such patients.

Objective To study the incidence, demographic data, pathogenic bacteria, appropriate antibiotics choices and outcome for patients suffered from post-TRPB bacteraemia

Method The medical records of Urology in-patients who and had undergone TRPB in Princess Margaret Hospital from 2004-2009 and developed post-TRPB bacteraemia were reviewed retrospectively. The indications for biopsy were generally elevated serum prostate specific antigen, abnormal findings on a digital rectal examination, or both. All biopsies were performed with the patient hospitalized. Ciprofloxacin and metronidazole was administered as antibiotic prophylaxis. The incidence, demographic data, time to positive blood culture, antibiotic prophylaxis, empirical antibiotics and definitive antibiotic prescribed for post-TRPB bacteraemia, pathogenic bacteria and antibiotics susceptibility profile in blood culture and urine culture results were evaluated.

Results 2540 patients undergone TRPB in the study period and 11 patients (0.43%) developed bacteraemia within 30 days of biopsy. Among a total of 12 blood culture isolates, 66.7% were fluoroquinolone resistant pathogens, 83.3% were sensitive to ticarcillin/ clavulanate, 75% isolates were sensitive to ampicillin/ clavulanate, and 100% were sensitive to imipenem and amikacin. Prevalence of extended spectrum lactamase producing E. coli was 33.3%

Conclusion The management of bacteraemia complicating transrectal prostate biopsy depends on the recognition of its clinical features, the usual pathogenic organisms and their antimicrobial susceptibility. When patients present with post-prostate biopsy infective symptoms with bacteraemia, nearly 70% were associated with fluoroquinolone resistant pathogens. The recommended empirical treatment for patients receiving ciprofloxacin and metronidazole as antibiotic prophylaxis includes timentin, augmentin or amikacin. Cabapenems could be considered if patients are clinically unstable or do not response to the empirical antibiotics, before the availability of culture results. Cephalosporins are not recommended due to the low susceptibility of isolates observed.