Bacteriology profile of febrile infectious complications after transrectal ultrasound-guided prostate biopsy

Infection and fever are a major issue of transrectal ultrasound (TRUS)-guided prostate biopsy related complications. The aim of the present study is to evaluate the incidence and bacteriology profile of infectious complications and fever after prostate biopsies. A total of 5027 patients underwent prostate biopsy from July 2005 to December 2010 at our center. Three different prophylactic antibiotic protocols were administered 20 minutes before biopsy. The choice of protocols was according to the attending physician's preference. Patient data were reviewed for prostate pathology, medical comorbidities, risk factors for urosepsis, use of prophylactic antibiotics, causative organisms, and antibiotic sensitivity patterns in both blood and urine cultures. Seventy patients (1.39%) developed fever after biopsy. The average age was 71 years, the average calculated weight of the prostate was 50.5 ± 22 g, and the median prebiopsy prostate-specific antigen (PSA) level was 8.48 ng/mL. Among 21 urine-positive patients, seven (33.3%) urine cultures yielded Escherichia coli (E. coli) and 10 (47.6%) yielded Gram-negative bacilli. None of the patient factors or coexisting comorbidities, prebiopsy pyuria, or prostate cancer, was significantly associated with the development of fever after biopsy. There was no significant difference between each group of prophylactic antibiotic protocols. Our study demonstrated an overall postbiopsy febrile complicating infection rate of 1.39%. E. coli was the most common pathogen. Fluoroquinolones or second generation cephalosporins are suggested as the initial choice in patients with postbiopsy fever.