Platinum Priority – InfectionsEditorial by Riccardo Bartoletti and Tommaso Cai on pp. 528–529 of this issueInfective Complications After Prostate Biopsy: Outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, A Prospective Multinational Multicentre Prostate Biopsy Study☆
Introduction
Prostate biopsy (P-Bx) is currently an essential procedure for prostate cancer diagnosis [1] and a frequently performed procedure in urology with an estimated 1 million cases each year in Europe. Following the introduction of transrectal ultrasound-guided P-Bx [2], this procedure has been widely accepted and optimised in recent years, continuously following the transrectal route [1]. A systematic review on randomised controlled studies (RCTs) on antibiotic prophylaxis in transrectal P-Bx showed a significant reduction in the risk of bacteriuria compared with placebo [3]. Reductions in symptomatic urinary tract infections (UTIs) and bacteremia were also seen but did not reach statistical significance [3]. Clinical guidelines therefore recommend antibiotic prophylaxis, typically with a oral fluoroquinolone, prior to transrectal P-Bx [4], [5]. Several reports have recently suggested an increased rate of infective complications following transrectal P-Bx in both North America [6], [7] and Europe [8]. The reasons for this increase and the factors associated with a higher susceptibility to infection remain largely unknown.
The aim of this international study was to evaluate the worldwide prevalence of infective complications after P-Bx and determine whether putative risk factors are associated with a higher rate of infection.
Section snippets
Study design
This prospective observational multinational multicentre epidemiologic study was performed as a part of the annual worldwide Global Prevalence Study on Infections in Urology (GPIU) in 2010 and 2011. The GPIU study has been performed annually since 2003 and consists of a 1-d prevalence census of infections experienced by patients hospitalised in urology units. It is organised by the board of the European Section for Infections in Urology (ESIU) [9], [10]. The study was endorsed and sponsored by
Results
A total of 84 centres in Africa (n = 2), Asia (n = 11), Europe (n = 67), and South-America (n = 4) participated in the GPIU prostate biopsy study (see appendix). The centres included a median of 4 evaluable patients for each year of participation (range: 1–25; standard deviation [SD]: ±6.7). A total of 702 men were included across the two study years (2010, n = 385; 2011, n = 317). Median patient age was 66 yr (range: 40–90; SD: ±8.0). Table 1 shows the biopsy performance parameters.
Outcome at 2 wk was
Discussion
Millions of men undergo P-Bx throughout the world each year as part of the accepted diagnostic pathway for prostate cancer [6]. Recently retrospective studies from Canada [7] and the United States [6] and one prospectively performed study from Europe [8] reported an apparent increase in the incidence of infective complications after transrectal P-Bx. In this study we found that just over 5% of men experienced symptomatic UTI after P-Bx, which resulted in serious morbidity in about 70% of cases
Conclusions
In this prospective multinational study on infective complications after P-Bx, a significant rate of infective complications after P-Bx was observed to be present worldwide. Our study supports the findings of others in suggesting that the presence of faecal fluoroquinolone-resistant bacteria is the most important risk factor. If this is the case, strategies to identify fluoroquinolone-resistant bacteria should be sought so as to decrease infective complications after P-Bx. This important and
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