Infections following prostate biopsies: Tackling the challenge

24 November 2016

Tackling infectious complications remains a tough challenge, but urologists can overcome this problem through a concerted, multi-pronged approach that combines antibiotic stewardship with strict adherence to guideline recommendations.

“It is important to know the prevalence of these infections and the risks of individual patients,” said Tomasso Cai (IT) during his lecture on prostate biopsies and the risks of infections at the 5th EAU Section of Urological Imaging (ESUI16) which opened today in Milan, Italy.

According to Cai, in the United States alone, there is an estimated 5% of 1.3 million cases which translates to around 65,000 infectious cases following prostate biopsies. In Europe the same trend is happening which also means millions in additional healthcare costs.

“Required hospitalization occurs at around 3% with a hospitalization stay of around five to nine days. The increased risk of overall hospitalization has gone up to 2.65-fold in the last few years,” according to Cai.

Cai stressed that the most crucial aspect is risk assessment for selecting patients at higher risk for infective complications. He further noted that targeted antimicrobial prophylaxis was linked to a reduction in infectious cases.

In his recommendations, he said that the use of povidone-iodine in men before transrectal prostate biopsy besides antibiotic prophylaxis can reduce the high risks of complications.

“Discuss with microbiologists and know the prevalence of ESBL pathogens and superbugs,” Cai said, and added: “Know the characteristics of the pathogen, evaluate the risk factors of the patient and identify or have good choice of antibiotics.”

More important, Cai said, is diligent adherence to guidelines. “We also need to stick to the EAU Guidelines on urological infections,” he recommended.