Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Jul 24, 2015; 4(2): 78-82
Published online Jul 24, 2015. doi: 10.5410/wjcu.v4.i2.78
Infectious complications after prostate biopsy: Time to rethink our clinical practice
Tommaso Cai, Paolo Verze, Riccardo Bartoletti, Vincenzo Mirone, Truls E Bjerklund Johansen
Tommaso Cai, Department of Urology, Santa Chiara Regional Hospital, 38123 Trento, Italy
Paolo Verze, Vincenzo Mirone, Department of Urology, University of Naples, 80100 Naples, Italy
Riccardo Bartoletti, Department of Urology, University of Florence, 50100 Florence, Italy
Truls E Bjerklund Johansen, Department of Urology, Oslo University Hospital, 0001 Oslo, Norway
Author contributions: Cai T, Verze P and Bartoletti R contributed equally to this work; Mirone V and Bjerklund Johansen TE revised the paper.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected byan in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tommaso Cai, MD, Department of Urology, Santa Chiara Regional Hospital, Largo Medaglie d’Oro 9, 38123 Trento, Italy. tommaso.cai@apss.tn.it
Telephone: +39-461-903306 Fax: +39-461-903101
Received: December 9, 2014
Peer-review started: December 11, 2014
First decision: January 8, 2015
Revised: May 21, 2015
Accepted: June 9, 2015
Article in press: June 11, 2015
Published online: July 24, 2015
Abstract

Prostate biopsy is a very common procedure performed worldwide which still represents the only way for prostate cancer diagnosis and reference point for subsequent treatments. Even if transrectal prostate biopsy is considered a safe procedure, it may be accompanied by infective complications, ranging from asymptomatic bacteriuria to symptomatic urinary tract infections and sepsis. During the recent decade we observed an increasing number of infectious complications and subsequent hospitalizations after and transrectal prostate biopsy. The most probable reason for the increasing rate of infectious complications after prostate biopsy is the increasing antimicrobial resistance, especially to the current first-line recommended fluoroquinolone antibiotics. We believe the time has come to re-think our current practice of diagnosing prostate cancer. We need to focus on the selection of patients at higher risk of infective complications, on microbiological sampling of the faecal flora prior to biopsy to identify resistance to specific agents, on the number of biopsy cores, on the biopsy route (perineal or transrectal approach) and, finally, consider alternative antibiotics with improved susceptibility to be used for prophylaxis.

Keywords: Prostate cancer, Prostate biopsy, Transrectal biopsy, Rectal swab, Antibiotic prophylaxis

Core tip: Transrectal biopsy of the prostate is generally considered a safe procedure used for obtaining tissue samples for the histological diagnosis of prostate carcinoma. However, in the last years we observed a higher rate of infective complications, ranging from asymptomatic bacteriuria to sepsis that continued to be the principal cause of hospital admission after procedure. The higher rate of sepsis could be due to the emerging resistance to fluorquinolones, in particular to ciprofloxacin. New strategies for antibacterial prophylaxis need to be purposed.