Bacterial sepsis after prostate biopsy--a new perspective.

OBJECTIVES: To determine the incidence of sepsis following transrectal ultrasound (TRUS)-guided prostate biopsy at our center.

METHODS: We retrospectively reviewed a group of 24 men who presented with urosepsis after undergoing TRUS biopsy at our center.

RESULTS: Of the 24 men, 22 were given prophylactic ciprofloxacin. The median time to presentation of sepsis was 1 day after biopsy. The median length of hospitalization was 4 days. Escherichia coli was the most frequent cause of urosepsis (67%). Variable resistance patterns were observed. Enterobacter cloacae and Streptococcus viridans were isolated in 2 cases. No bacteria were isolated in 6 cases. Two patients who received extensive antibiotic prophylaxis still developed urosepsis. Treatment of patients infected with multiresistant anaerobic strains using metronidazole among others, proved successful. High sensitivities toward cefazolin, gentamicin, and tobramycin were observed. The number of cases reported was likely an underestimation, because some patients may have reported to other hospitals and were not captured by this study. In addition, some patients may not have developed infection and urosepsis despite harboring ciprofloxacin-resistant bacteria.

CONCLUSIONS: Prophylactic ciprofloxacin is still a useful option for the prevention of urosepsis after TRUS biopsy, as the incidence is relatively low. For the patient who develops urosepsis after TRUS biopsy, ciprofloxacin resistance needs to be suspected and the treatment regime should be tailored to the resistance profiles of the local region, the patient's medical history, and the culture and sensitivity reports.