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The problem of infection after prostatic biopsy: the case for the transperineal approach
Abstract:
The incidence of infection after needle biopsy of the prostate by different techniques was compared in 45 patients. Aerobic and anaerobic culture was made of the biopsy needle, prostate, urine and blood. In addition, endotoxin assays were determined by a new chromogenic method using Limulus lysate. All of the patients undergoing transrectal biopsy were found to have a bacteraemia; 27% were symptomatic and 87% had a post-operative urinary tract infection. A double-blind controlled trial using cefamandole with the premedication showed a significant reduction in the incidence of bacteraemia to 53% and the prevention of a urinary tract infection. Following transperineal biopsy, although the incidence of bacteraemia was 40% and urinary tract infection 27%, none of these patients was symptomatic and the organisms causing the bacteraemia were predominantly skin contaminants. The endotoxin assays showed differences between the groups with higher endotoxin values in the unprotected transrectal group.
Insights
Prostate needle biopsy infection rates were compared. Transrectal biopsy caused high rates of bacteremia and urinary tract infections, reduced by cefamandole antibiotic prophylaxis.
Area of Science:
- Urology
- Infectious Diseases
- Medical Microbiology
Background:
- Prostate needle biopsy is a common procedure for diagnosing prostate cancer.
- Infection is a significant complication following prostate biopsy, necessitating preventative strategies.
Purpose of the Study:
- To compare infection incidence after different prostate needle biopsy techniques.
- To evaluate the efficacy of antibiotic prophylaxis in reducing post-biopsy infections.
Main Methods:
- Compared transrectal versus transperineal prostate needle biopsy techniques in 45 patients.
- Performed aerobic/anaerobic cultures of biopsy needle, prostate, urine, and blood.
- Assessed endotoxin levels using Limulus lysate assay.
- Conducted a double-blind controlled trial with cefamandole premedication for transrectal biopsies.
Main Results:
- All transrectal biopsy patients developed bacteremia (40% symptomatic), with 87% experiencing post-operative urinary tract infections (UTIs).
- Cefamandole prophylaxis significantly reduced bacteremia to 53% and prevented UTIs in transrectal biopsy patients.
- Transperineal biopsy showed lower bacteremia (40%) and UTI (27%) rates, with predominantly skin contaminants and no symptomatic infections.
- Higher endotoxin levels were observed in the unprotected transrectal biopsy group.
Conclusions:
- Transrectal prostate needle biopsy is associated with a high risk of post-procedural infection, including bacteremia and UTIs.
- Antibiotic prophylaxis, such as cefamandole, is effective in reducing the incidence of infection after transrectal prostate biopsy.
- Transperineal biopsy appears to carry a lower risk of symptomatic infection compared to transrectal biopsy.