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Infectious complications of prostate biopsy: winning battles but not war

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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.

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Fig. 1

Source: L’Institut Mutualiste Montsouris. Paris, France

Fig. 2

Source: L’Institut Mutualiste Montsouris. Paris, France

Fig. 3

Source: L’Institut Mutualiste Montsouris. Paris, France

Fig. 4

Source: L’Institut Mutualiste Montsouris. Paris, France

Fig. 5

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Authors and Affiliations

  1. International School of Medicine, Medipol Mega Hospital, Istanbul Medipol University, Bagcilar, 34214, Istanbul, Turkey

    Okan Derin

  2. Hospital das Clinicas da Universidade de São Paulo, São Paulo, Brazil

    Limírio Fonseca

  3. Department of Urology, L’Institut Mutualiste Montsouris, Paris, France

    Rafael Sanchez-Salas

  4. Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Matthew J. Roberts

  5. Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia

    Matthew J. Roberts

  6. Nepean Urology Research Group, Kingswood, NSW, Australia

    Matthew J. Roberts

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  1. Okan Derin
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  2. Limírio Fonseca
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  3. Rafael Sanchez-Salas
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  4. Matthew J. Roberts
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Protocol/project development: OD. Data collection or management: OD, LF, MJR. Manuscript writing/editing: OD, LF, RSS, MJR.

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Derin, O., Fonseca, L., Sanchez-Salas, R. et al. Infectious complications of prostate biopsy: winning battles but not war. World J Urol 38, 2743–2753 (2020). https://doi.org/10.1007/s00345-020-03112-3

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