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Biopsy Core Number Is the Independent
Predictor of Febrile Urinary Tract Infection after
Transrectal Ultrasound Guided Prostate Biopsy
前列腺切片針數為術後尿道感染的獨立預測因子
蔡博超1、姜秉均1、蒲永孝1、劉詩彬1、姜宜妮1,2 、
余宏政1 、 王碩盟1 、 張宏江1 、 黃昭淵1
1台大醫院
泌尿部;2署立基隆醫院 泌尿科
Introduction(1)
► Infection
is a well-known complication of transrectal
ultrasound guided prostate biopsy (TRUSP-Bx).
► Wide
variability in antibiotics prophylaxis has been
reported.
► The
European Association of Urology (EAU)
guidelines on prostate cancer state that “quinolones
are the drug of choice in TRUSP-Bx.”
Introduction(2)
►
Sieber et al reported the increase of the complicated UTI
after TRUSP-Bx was insignificant from sextant biopsy to 10
or 12-core biopsy in a 1000 patients cohort.
Urology. 70: 498-500, 2007
►
Recent literatures have demonstrated an emergence of
increasing infectious complications and fluoroquinolone
(FQ)-resistant infections following TRUSP-Bx.
►
To determine whether the biopsy core number is
associated with febrile urinary tract infection (fUTI) after
transrectal ultrasound guided prostate biopsy (TRUSP-Bx).
PATIENTS AND METHODS
Patients and methods(1)
► Retrospectively
reviewed the electronic medical
records of consecutive males receiving levofloxacin
500mg single dose prophylaxis in TRUSP-Bx in
National Taiwan University Hospital (NTUH) between
January 2005 and December 2010
 Indications for biopsy: (1) an increased PSA level
and/or (2) abnormal digital rectal examination (DRE).
 Exclusion: (1) a pre-existing diagnosis of prostate
cancer (2) those who did not follow the TRUSP-Bx
protocol.
Patients and methods(2)
► Definition
of febrile UTI :
 (1) Body temperature greater than 38。C in two weeks
after biopsy,
 (2) New-onset lower urinary tract symptoms or acute
epididymitis,
 (3) Absence of other sources of infection.
Patients and methods(3)
► Transrectal
Ultrasound Guided Prostate Biopsy
Protocol in NTUH
 Levofloxacin 500mg single dose one hour before biopsy.
 Inpatient setting, sextant biopsy or ≧12-core biopsy
(with/without finger-guided nodular biopsy) with general
anesthesia or spinal anesthesia.
 Outpatient setting, only sextant biopsy in consideration of
discomfort related to solely perianal-intrarectal topical
lidocaine gel anesthesia.
 DRE before the procedure to avoid “trans-fecal” biopsy.
 Rectal disinfection with iodine swab.
RESULTS
Result
►A
total of 2951 TRUSP-Bx was included between
January 2005 and December 2010.
► The median age was 68 years (ranges 25 to 95).
► The median PSA level was 9.7 ng/ml (ranges 0.1 to
7500)
► 962 (32.6%) males were diagnosed as prostate
cancer after biopsy.
► 92 (3.1%) males’ pathology reports revealed
histological prostatitis
median test
(1.12%)
Multivariate study
► Multivariate
model with logistic regression analysis
which included biopsy core number and age.
► Biopsy
core number (≧12core) was still the predictor
of febrile UTI with p value = 0.024.
Result
► 35
(1.12%) patients experienced febrile UTI after
TRUSP-Bx.
► 24 (68.6%) had positive urine and/or blood cultures:





E. coli in 19 (79.2%) - 16 (84.2%) FQ-resistant.
Klebsialla pneumoniae in 2 (8.3%),
Enterobacter cloacae in 1 (4.2%),
Serratia marcescens in 1 (4.2%),
Enterococcus species in 1 (4.2%).
DISCUSSION
Discussion(1)
► 2010
EAU guidelines on prostate cancer, the
cumulative infection rate following TRUSP biopsy
was 2.5%.
► In our study, the febrile UTI rates after TRUSP
biopsy range from 0.60 to 1.75 % from 2005 to
2010. (overall 1.12%)
► Our results suggest that levofloxacin remains an
effective prophylaxis for TRUS-guided prostate
biopsy.
Discussion(2)
► This
is the largest study for examining the efficacy
of single dose levofloxacin prophylaxis in TRUSPBx.(A total of 2951 cases)
► In our study, ≥12core biopsy was the
independent predictor of febrile UTI compared to
sextant biopsy.
► Sieber et al reported increase insignificantly in the
complicated UTI from sextant biopsy to 10 to 12core biopsy in a 1000 patients cohort.
Urology. 70: 498-500, 2007
Discussion(3)
► Retrospective
study by reviewing electronic
medical records in a tertiary referral center.
► Failed to evaluate all the potential risk factors of
infectious complications.
CONCLUSION
Conclusion
► Biopsy
core number serves as the predictor of
febrile UTI following TRUSP-Bx.
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