Infectious Complications Following Transrectal Ultrasound Guided Biopsy of the Prostate (Edmonton Zone)

Student Researcher:
Alexandra Bain

Supervisor / Principle Investigator:
Dr. Eric Estey

Additional Authors:
Dr. Stephanie Smith

MD Class of 2019


Background: Transrectal ultrasound (TRUS) guided biopsy is currently the standard technique to obtain tissue for the diagnosis of prostate cancer. This procedure has a number of potential infectious complications including bacteremia and urosepsis. To reduce the risk of these complications, prophylactic antibiotics are prescribed but the choice and dosage is not standardized, and there is an increasing incidence of quinolone resistant infections. We wanted to analyze the rates of infectious complications post-TRUS biopsy in Edmonton along with type and dosage of prophlyactic antibiotics.

Methods: Retrospective review was done on patients who received a TRUS prostate biopsy between January - December 2017. All patients medical and laboratory records were reviewed as pertaining to their prostate biopsy. A post biopsy infection was defined as a positive blood or urine culture within 10 days of the procedure.

Results: Data was available for 1480 of the patients who received a TRUS prostate biopsy. Antibiotic prophylaxis was prescribed in all patients with 1226 (83%) receiving ciprofloxacin and 252 (17%) receiving alternative regimens. Post biopsy bacteremia or positive urine cultures occurred in 68 patients (4.6%) with 25 (1.7%) having a positive urine culture and 43 (2.9%) having a positive blood culture. One patient required a 48 hour ICU admission for hemodynamic support. Ciprofloxacin resistant E. coli was isolated in 45 (66%) of the patients.

Discussion: Infectious complications post TRUS prostate biopsy are a significant source of patient morbidity and health care costs in the Edmonton Zone, with higher reported rates than other centers. This review provides the opportunity to standardize antibiotic prophylaxis and compliance. Further research will need to be done to identify individuals who required alternate prophylactic agents due to colonization with Cipro resistant E coli. Patients and physicians need to be educated on the signs, symptoms and management of post TRUS prostate biopsy sepsis.