AUA reiterates stance on infections after needle biopsy

Current research suggests that the rate of infectious complications, including sepsis, after transrectal prostate needle biopsy may be increasing, and urologists need to be aware of this trend, the AUA said in a recent statement.

The research has caught the attention of the national news media, and has been highlighted in reports on the Bloomberg and National Public Radio Web sites, among others.

According to the AUA Best Practice Statement on Urologic Surgery Antimicrobial Prophylaxis, the antimicrobial of choice prior to prostate needle biopsy is a fluoroquinolone or a second- or third-generation cephalosporin. Alternative agents include an aminoglycoside plus metronidazole (Flagyl, Metro) or clindamycin (Cleocin). Oral fluoroquinolones are the most commonly used agents in clinical practice.

The primary reason for post-biopsy infections appears to be the presence of fluoroquinolone-resistant organisms in the fecal flora, the AUA statement said. Risk factors that predict the presence of resistant bacteria are not well defined, but may include previous fluoroquinolone administration and patient occupation as a health care worker.

Prior to performing a transrectal prostate biopsy, urologists should consider broadening the antimicrobial coverage in patients with these risk factors, the AUA advised. Furthermore, in men with signs of an infection after prostate needle biopsy, the presence of resistant bacteria is likely, and broad-spectrum treatment should be initiated, according to the AUA.

Look for a "Hands On" article on this topic by experts from Northwestern University in the July 2011 issue of Urology Times.