Updated prostate Bx paper outlines preventive strategies
Risk assessment, directed or augmented prophylaxis among recommendations
Post-Bx infection: Factors to consider
There are a couple of considerations regarding the risk of post-biopsy infections. First, the reported range is quite wide, which raises questions about the definitions and data collection in those studies. Second, the rate of FQ resistance in most communities is 20%-25%, yet the FQ-resistant bacterial infections occur in only a fraction of those patients. Clearly, there is more to the risk of post-biopsy infections than just the prophylactic antibiotics. There are certainly some other factors that influence the risk of infection such as bacterial load, host immunity, timing, and serum levels of antibiotics, and require further study.
A number of preventive strategies are catalogued in this white paper, including risk assessment through history taking and directed or augmented antibiotic prophylaxis. Pre-biopsy rectal culture-guided antibiotics are reported by several authors to lower infection rate. Others have reported a similar reduction in infections through augmented or adjusted antibiotics based on clinical risk factors such as FQ use in the previous 6 months, previous infections, overseas travel, and working in a health care setting. Other useful measures that have reportedly reduced the infection rate include povidone-iodine rectal prep and needle wipes, and adherence of general principles to prevent cross contamination or use of disposable needle guides.
While it’s extremely important to learn and understand the extent of the infectious issues following prostate biopsy, there is a risk in overstating the problem as well. For example, raising undue alarm about the risk of sepsis may dissuade some patients and urologists from adopting active surveillance strategies for low-risk prostate cancer.
Trying to identify the single best method of infection prevention is less important than being aware of the risk in one’s own practice or center. For every patient, risk assessment through history taking, adjusting the antibiotic regimen, and knowledge of local antibiograms will go a long way to keep the problem of post-biopsy infections under control.
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