Abstract

Background

Prostate biopsy is a standard tool for diagnosing prostate cancer, with more than 4 million procedures performed worldwide each year. Infectious complications and economic burden are reportedly rising with continued use of trans-rectal ultrasound-guided biopsy, despite the transperineal approach being associated with less infectious complications.

Objective and methods

In this review, the contemporary literature on pathophysiology, epidemiology, risk factors, causative organisms and emerging approaches for prevention of infectious complications are outlined.

Results

Management of infectious complications after TRUSB has caused significant financial burden on health systems. The most frequent causative agents of infectious complications after prostate biopsy are Gram-negative bacilli are particularly concerning in the era of antibiotic resistance. Increasing resistance to fluoroquinolones and beta-lactam antibiotics has complicated traditional preventive measures. Patient- and procedure-related risk factors, reported by individual studies, can contribute to infectious complications after prostate biopsy.

Conclusions

Recent literature shows that the transrectal ultrasound-guided prostate biopsy results in higher infectious complication rate than the transperineal prostate biopsy. NAATs, recently introduced technique to detect FQr may detect all antibiotic-resistant rectal microbiota members—included MDRs—although the technique still has limitations and economical burdens. Transient solutions are escalating antibiotic prophylaxis and widening the indications for TPB.

中文翻译：

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前列腺活检的传染性并发​​症：赢得战争，但未赢得战争

摘要

背景

前列腺活检是诊断前列腺癌的标准工具，每年在全球范围内执行超过400万次手术。据报道，尽管经会阴方法的感染并发症较少，但继续使用经直肠超声引导的活检仍会增加感染并发症和经济负担。

目的与方法

在这篇综述中，概述了有关病理生理学，流行病学，危险因素，病原生物和预防感染性并发症的新兴方法的当代文献。

结果

TRUSB术后感染性并发症的管理已给卫生系统造成了沉重的经济负担。前列腺活检后感染并发症最常见的病因是革兰氏阴性杆菌，在抗生素耐药性时代尤其受到关注。对氟喹诺酮类和β-内酰胺类抗生素的耐药性增加使传统的预防措施复杂化。个别研究报告的与患者和手术相关的危险因素可能会导致前列腺穿刺活检后的感染并发症。

结论

最近的文献表明，经直肠超声引导的前列腺活检比经会阴前列腺活检具有更高的感染并发症发生率。NAATs是最近引入的检测FQr的技术，尽管该技术仍然存在局限性和经济负担，但它可能会检测出所有抗生素耐药的直肠微生物群成员，包括MDR。瞬态解决方案正在逐步扩大抗生素的预防范围，并扩大了TPB的适应症。