So… over the last year and having done several hundred prostate biopsies…I have had about 6 or seven people get an infection. That’s not many, but it is a dramatic thing for the patient dealing with it. Usually they are fine for a day or two and then begin to feel puny, maybe some voiding symptoms, possibly chills and low-grade fever that progresses. It is a frustrating thing because when this happens it is usually an organism that is not treated by common oral meds such as Cipro. Often times when the culture is obtained it is Ecoli that is resistant to oral meds. Nationally I am told now that about 20% of Ecoli infections are resistant to Cipro. Cipro is the drug we have used for years to prevent infections and it has done well. This is now changing.
So…enter rectal swabs to culture the rectal area before the biopsy. If the culture is a Ecoli resistant type, the patient is treated before the biopsy with the “right” antibiotic and hence the thinking goes will further prevent infections. I am for it. These infections are not your garden variety bladder infections of females…the bugs are bad bugs.
So…the logistics and cost of this? Well… if a man is in my office and I anticipate that he’ll need and consent to a biopsy, I plan to get the culture at the time of the rectal exam for the evaluation of an elevated PSA. Biopsies are usually scheduled several days out so there will be time to check for the culture result and use the appropriate antibiotic before the biopsy.
In a way this is a lot like screening i.e. we will be doing things on many people to protect a few.
Wonder what the “anti screening” crowd will say about this?
Complications after prostate biopsy: data from SEER-medicare.
J Urol. 2011; 186(5):1830-4 (ISSN: 1527-3792)
Loeb S ; Carter HB ; Berndt SI ; Ricker W ; Schaeffer EM Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. firstname.lastname@example.org
PURPOSE: More than 1 million prostate biopsies are performed annually among Medicare beneficiaries. We determined the risk of serious complications requiring hospitalization. We hypothesized that with emerging multidrug resistant organisms there may be an increasing risk of infectious complications.
MATERIALS AND METHODS: In a 5% random sample of Medicare participants in SEER (Surveillance, Epidemiology and End Results) regions from 1991 to 2007 we compared 30-day hospitalization rates and ICD-9 primary diagnosis codes for admissions between 17,472 men who underwent prostate biopsy and a random sample of 134,977 controls. Multivariate logistic and Poisson regression were used to examine the risk and predictors of serious infectious and noninfectious complications with time.
RESULTS: The 30-day hospitalization rate was 6.9% within 30 days of prostate biopsy, which was substantially higher than the 2.7% in the control population. After adjusting for age, race, SEER region, year and comorbidities prostate biopsy was associated with a 2.65-fold (95% CI 2.47-2.84) increased risk of hospitalization within 30 days compared to the control population (p <0.0001). The risk of infectious complications requiring hospitalization after biopsy was significantly greater in more recent years (p(trend) = 0.001). Among men undergoing biopsy, later year, nonwhite race and higher comorbidity scores were significantly associated with an increased risk of infectious complications.
CONCLUSIONS: The risk of hospitalization within 30 days of prostate biopsy was significantly higher than in a control population. Infectious complications after prostate biopsy have increased in recent years while the rate of serious noninfectious complications is relatively stable. Careful patient selection for prostate biopsy is essential to minimize the potential harms.