Prosbiotate: a multicenter, prospective analysis of infectious complications after prostate biopsy.

PURPOSE: Prostate biopsy side effects have a role in the controversy over screening for prostate cancer. We measured the precise incidence of infection after prostate biopsy and determined risk factors. MATERIALS AND METHODS: We performed a prospective, multicenter study in France from April to June 2013. All prostate biopsies done during this period were included in study. A web based questionnaire was used to identify patient characteristics, biopsy methods and postoperative infectious episodes. External audit helped ensure data completeness. The primary outcome was the post-biopsy infection rate. We determined risk factors for infectious complications using univariate and multivariate analysis. RESULTS: The study included 2,718 patients, of whom 6% reported receiving antibiotics in the previous 6 months and 7.4% had a history of prostatitis. Recommended antibiotic prophylaxis consisting of 2 fluoroquinolone tablets 2 hours before examination for prostate biopsy was noted in 78.3% of cases. Post-biopsy sepsis was found in 76 subjects (2.8%). On multivariate analysis predictors of post-biopsy sepsis were noncompliance with antibiotic prophylaxis guidelines (OR 2.3, 95% CI 1.4-3.9, p = 0.001), antibiotic treatment in the previous 6 months (OR 2.1, 95% CI 1.1-3.9, p = 0.015) and a history of prostatitis (OR 1.7, 95% CI 1.2-2.4, p = 0.002). CONCLUSIONS: In this study the incidence of post-prostate biopsy sepsis was 2.8% and no deaths were reported. Risk factors identified on multivariate analysis were noncompliance with antibiotic prophylaxis according to guidelines, antibiotic treatment in the previous 6 months and a history of prostatitis.

[Epidemiology and treatment of acute prostatitis after prostatic biopsy]. / Epidémiologie et traitement des prostatites aigues après biopsie prostatique.

OBJECTIVE: Acute prostatitis is the main complication of prostatic biopsies (PB) and sometimes requires hospitalisation and appropriate antibiotic therapy. This study evaluated the pathogens responsible and proposes a statistically adapted empirical antibiotic therapy. PATIENTS AND METHODS: This retrospective (from 2000 to 2006) two-centre study included 17 patients hospitalised for acute prostatitis after PB in a series of 1,216 biopsies. Bacteriological documentation was based on urine cultures, blood cultures, identification of bacteria and antibiotic susceptibility testing. RESULTS: All patients received prophylactic antibiotics with a single dose of systemic fluoroquinolone at least 1 h before PB. Bacterial identification was possible in fourteen cases: E. coli (nine cases), Proteus mirabilis (one case), Klebsiella pneumoniae (one case), Enterococcus faecalis (one case), Staphylococcus Spp (one case), Clostridium perfringens (one case). Only urine culture was positive in 6 cases (35%), only blood culture was positive in 3 cases (17%), and urine cultures and blood cultures were positive and concordant in 5 cases (29%). A high rate of resistance of E. coli to fluoroquinolones was observed in 88% of cases and to cotrimoxazole in 77% of cases. However, the strain was susceptible to second and third generation cephalosporins (2GC and 3GC) and amikacin in 100% of cases. Prostatitis was associated with epididymo-orchitis (3 cases), acute urinary retention (4 cases) and infective endocarditis (1 case). CONCLUSIONS: Identification of the micro-organism responsible for acute prostatitis after biopsy requires a combination of blood cultures and urine cultures. Empirical antibiotic therapy is based on the use of 2GC or 3GC, alone or in combination with amikacin depending on the severity of the clinical features.

Resistance and virulence potential of uropathogenic Escherichia coli strains isolated from patients hospitalized in urology departments: a French prospective multicentre study.

We characterized antibiotic resistance and virulence of uropathogenic Escherichia coli (UPEC) strains isolated from urinary tract infections (UTIs) in patients hospitalized in urology departments. A prospective multicentre study was initiated from March 2009 and lasted until February 2010 in French urology units. All patients with asymptomatic bacteriuria (ABU), acute cystitis, acute pyelonephritis or acute prostatitis in whom UPEC was detected were included. Antimicrobial resistance and virulence factors were compared among the different groups. To identify independent associations between virulence markers and the risk of UTI, we used a multivariate logistic regression. We included 210 patients (mean age: 65.8 years; 106 female). Episode of UTI was community acquired in 72.4 %. ABU was diagnosed in 67 cases (31.9 %), cystitis in 52 cases (24.7 %), pyelonephritis in 35 cases (16.7 %) and prostatitis in 56 cases (26.7 %). ABU was more frequent in patients with a urinary catheter (76.1 vs 23.9 %, P<0.001). The resistance rate was 7.6 and 24.8 % for cefotaxime and ciprofloxacin, respectively. UPEC isolated from infections belonged more frequently to phylotypes B2 and D (P =0.07). The papG allele II and papA, papC, papE, kpsMTII and iutA genes were significantly more frequent in infecting strains (P<0.05). In multivariate analysis, strains susceptible to ciprofloxacin were significantly associated with papG allele II (P=0.007), kpsMTK1 (P<0.001) and hlyA (P<0.001) compared with the ciprofloxacin-resistant strains. To the best of our knowledge, this is the first study evaluating the antibiotic resistance and virulence features of UPEC isolated from patients hospitalized in urology departments. High resistance rates were observed, notably for ciprofloxacin, highlighting the importance of a reinforced surveillance in this setting.

Clinical significance of routine urinary bacterial culture after transurethral surgery: results of a prospective multicenter study.

OBJECTIVES: The objective of this study was to evaluate the prevalence and the clinical outcomes of asymptomatic postoperative bacteriuria after transurethral operations, along with the need for postoperative urinalysis. METHODS: A prospective study of 456 patients who underwent transurethral resection of the prostate (TURP) or transurethral resection of the bladder (TURB) at 2 urological centers in France, between January 2008 and March 2009. All patients had urine cultures preoperatively, on the day of catheter removal, and at 1 month postoperatively. Only patients with symptoms suggesting a urinary tract infection were treated. Univariate logistic regression and multiple logistic regression were used to estimate the odds ratios and P values. RESULTS: TURP was performed in 217 patients, and TURB was performed in 239 patients. A total of 35 patients (7.6%) had positive postoperative urine cultures. Only 9 patients (1.9%) were treated. Patient age and postoperative catheterization duration were identified as risk factors for postoperative bacteriuria (OR = 1; 95% CI = 1.0-1.1; P = .03 and OR = 3.6; 95% CI = 2.3-5.7; P = .0001, respectively), and preoperative bacteriuria was not risk factor for postoperative bacteriuria (OR = 0.9; 95% CI = 0.3-1.4; P = .8). A total of 45 patients had a positive urinalysis at 1 month, and 29 presented an infectious complication during follow-up. A positive postoperative urinalysis was not a risk factor either for a positive urinalysis at 1 month or for an infectious complication during follow-up (OR = 3.2; 95% CI = 0.4-22.4, P = .2 and OR = 1.4; 95% CI = 0.4-4.9, P = .5, respectively). CONCLUSIONS: Based on our study findings, postoperative bacteriuria is not a risk factor for infectious postoperative complications. Therefore, routine postoperative urinalysis should be advocated only in symptomatic patients.