Bacterial sepsis following prostatic biopsy

Introduction & Objectives: Despite recent innovations, complications of prostate biopsy can occur. The most serious septic complications include urosepsis, which occurs in 0.3 to 1.3% of the cases. The aim of this study was a prospective monitoring of major septic complications occurring after transrectal prostate biopsy, the study of bacterial virulence factors and the exclusion of a common source of contamination. Materials & Methods: This prospective study was carried out between January 2009 and September 2010. The indications for carrying out the prostate biopsy conformed with those of the European Association of Urology 2007 guidelines. Complications were evaluated by direct observation in the first few hours after the biopsy and by telephone interviews 3, 7 and 30 days after the procedure. Preparation for the biopsy involved an enema and antibiotic prophylaxis with fluoroquinolone. Study of virulence factors was performed on three of the strains of Escherichia coli isolated from three different patients that were subjected to multiplex PCR analysis. The pathogenic strains are EHEC (EnteroHemorrhagic Escherichia coli), STEC (Shiga-Toxin producing), EIEC (EnteroInvasive), EPEC (EnteroPathogenic) and ETEC (EnteroToxigenic). Results: Between January 2009 and September 2010, 463 patients were enrolled in the study and 447 (96%) completed the telephone interview. Urosepsis occurred in ten patients (2.2%), and in two cases evolved into septic shock. The mean interval between performance of the biopsy and the patients’ admission to hospital was 40 hours. The mean age of the patients was 64.9 years. Of these ten patients, nine had a positive blood culture, of whom eight for Escherichia coli and one for Aeromonas hydrophila, Aeromonas caviae, and Aeromonas sobria. The patients with Escherichia coli infection all developed urosepsis within the first 48 hours after the procedure. In seven cases, the Escherichia coli isolated were resistant to fluoroquinolone and in one case, the Escherichia coli isolated produced an Extended Spectrum Beta-Lactamase (ESBL). Six Escherichia coli were classified as MultiDrug-Resistant Organisms (MDRO). The strains subjected to PCR were different and all gave negative results for virulence factors, Of the ten patients, one died after the onset of multi-organ failure. For the other nine, the mean time spent in hospital was 9 days (range, 6 – 15 days). Complete recovery was observed in all these cases, with no sequelae. Conclusions: Enterobacteriacee and, in particular, Escherichia coli are developing new drug resistances. The ESBL-producing strains are particular feared as they are resistant to all penicillins, to cepahlosporins, including third and fourth generation agents, and to aztreonam and are often cross-resistant to trimethoprim/ sulfamethoxazole and quinolones. At the time of discharge home, the patient must be appropriately informed to consult a doctor in the case of fever, in order that signs of sepsis are identified early.