Rectal swab culture to prevent infections after prostate biopsy in checking for prostate cancer? PSA screening all over again?



I ain’t the best, but I’m blessed.

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. stacyloeb@gmail.com

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.

PreMedline Identifier:21944136

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

5 Replies to “Rectal swab culture to prevent infections after prostate biopsy in checking for prostate cancer? PSA screening all over again?”

  1. Oh SSSSSS! not another arrow for the DETRACTORS. If one digs deeply enough the nasties tend to rear their ugly heads but is it not better to identify potential problems before they arise thus enabling methods to disable them?

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  2. My name is Esther, Frankie is my husband and he has prostate cancer. He was diagnosed since 2006 and we chose the watchful waiting instead of any conventional treatments. We chose the alternative by juicing consists of cellery, carrots, ginger and beets. And with that juicing i mixed Green Vibrance Powder. This is his breakfast i only do it once a day. I have been doing this for over 6 years aside from Dr Chi’s suplements in which I only gave to my husband for over a year consist of Myomin, Angiostop, Asparagus Extract, Reishi Mushroom and something to help his prostate I forgot the name. These are the main ones I gave him from Dr Chi’s suplements. And when he comes home i have another drink ready for him to drink Modified Citrus Pectin or Pectasol (google it n click the one it says Fighting Metastasis…..etc) with pineapple juice. This one I started over a year ago 2011 later part to present. I totally changed his diet no meat intake of any kind. I cooked mostly sauté garlic onions and tomatoes with veggies. On his first diagnosis his PSA was 10 after just juicing for over a month and a half his PSA went down to 2.2 and because of that I cancelled his robotic surgery or brachytherapy that was the reason why we decided to choose watchful waiting. And his PSA results vary from 2 to 2.3 to present. He had biopsies done 2006 2007 ( he bled fir 8 hours almost went to ER) and 2009 since then we never had it done. He had 2 MRI’s 2011 n 2012 all good result his cancer is contained. Now, here comes the problem there is a lab test done on him the PCA-3. The Moffitt Urologist advised him to have it done. The first result was indefinite that they repeated it after a month the second result was 58%. This one worries me at the same time I was not satisfied with the result. Also if you see the paper they used you will think it came from the trash can. It is very unprofessional copy of the result. I decided to bring my husband to JHU in Baltimore MD for the second time for opinion. The first time was for the biopsy in which the reading of Moffitt and JHU were different. But, that was fine to me cancer is cancer as long as his Gleason reading were the same 3+3=6. Few of the specimen taken from his biopsy have this reading and some are different report but all in all his cancer is contained. Also all his DRE are normal except the 11/2006 slight the year he was diagnosed dr felt just a little abnormality and his biopsy report are stage 1. The suggestion of JHU was surgery that was 2009. We did not follow their advise we continue the active surveillance or you called it watchful waiting. Our reason to go back to JHU was from the PCA-3 results. We saw the dr yesterday Dec 03, 2012. The dr was great very different from the first dr we saw at JHU. This one is more attentive and explained to us every questions I asked. He seems to be more compassionate to his patient. On his suggestion if he will take care of my husband and i will moved him from Moffitt here in Tampa where we are from he would like to do the biopsy every year. And this is the one my husband do not want unless the dr can convinced him that prostate biopsy do not spread the cancer cells. So we are in the process of thinking whether we want it or not to do this biopsy procedure because my husband believes that cancer is like a bee hives you shake it it gets mad like the bee bites while cancer spreads. I am writing this to you asking your suggestion if we should follow the dr’s advise to do this biopsy since nothing was done since 2009. I did my research work and finding it that there was a news published 2008 that biopsy can spread the cancer cells. What is your opinion and anyone there. Also, rectal swab was never done to my husband here in Moffitt. I do not know about this and that makes me mad because how could I missed this. I read about it and even PCA-3 can cause the spread of cancer cells. And I am very mad to myself that my husband maybe right after all that it is better if nothing is being done on him and I just continue my juicings. I am just so afraid of loosing him so i find a way to keep finding the best treatments fir him. I read everything all the treatment available and all if it had severe side effects. While we were at JHU they did the rectal swab for the first time n did the free PSA test. I forgot to mention that he is also taking supplements from Life Extension these Natural Prostate Pills and Viramin D 3. Thank you so much and i will be more than happy and lookibg forward to hear from you what is your suggestion.

    Sincerely,

    Mrs Esther Chaco
    phone number 813-465-3835

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  3. Also, lately I have been giving him soursop tea. I got the leaves of soursop n make it into tea. Please see this in search SOURSOP. When it is being given according to tge findings soursop is ten times equivalent to chemo therapy. Also I did lemongrass tea too by chopping this and boiled water first and then pour the chopped lemongrass when it turned to apple green turned off and transferred it to another burner. I let him drink it just once a day. I forgot to mention that I prepare water with lemon for his work. Lastly. I do make smoothie mostly black fruits if possible just lately can’t do it but I make sure I gave him fruits usually i give him pineapple juice to mix with his modified cutrus pectin.
    Continuation from the earlier comment

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  4. Some people are more likely than others to get bladder infections. Women tend to get them more often than men due to their urethra being shorter and closer to the anus. Among the women most likely to get bladder infections are women who are pregnant, going through menopause and using a diaphragm for birth control. Men who have prostate inflammation or enlargement will also be more likely to have bladder infections. Risk factors that apply to both men and women are; kidney stones, sexual intercourse with multiple partners, narrowed urethra, immobility such as recovering from hip fracture, not drinking enough fluids, bowel incontinence and catheterization. Elderly people and people with diabetes are also at higher risk of bladder infections.-

    Our personal blog
    <http://www.healthmedicinelab.com/strep-throat-symptoms/

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  5. Infections in our large group are down by adding omnicef to preBx regimen
    If the risk of infix is <2%, doesn't make sense to swab everyone
    Perhaps adding cephalosporin or gent I'm to at risk pts might be helpful or use of swab in multiple abx treated men with comorbidities or adv age might be way to go

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