The rate of severe urinary tract infections following transrectal ultrasound-guided biopsy for the detection of prostate cancer has been on the rise in Sweden, the authors of a study conducted there have concluded.
There has also been a twofold increase in the hospitalization of men for those infections during 5 years, authors Lundstrom et al wrote in the study, which appeared in the Journal of Urology
in May. In addition to noting the trend, the authors zeroed in on the factors that make post-biopsy infection most likely, including prior infection.
“The increasing risk of hospitalization is concerning, highlighting the importance of carefully evaluating indications for biopsy, especially in men at increased risk for infection,” the authors wrote.
The team conducted the study because “transrectal ultrasound-guided biopsy is the gold standard for detecting prostate cancer, but international reports suggest that increasing risks are associated with the procedure.”
In the study, they evaluated a sample of Swedish men in order to estimate the incidence and risk factors for infection after prostate biopsy, as well as 90-day mortality.
The population-based study followed 51,321 men from 2006 to 2011; data on the men was found in PCBaSe, a clinical, epidemiological database for prostate cancer research linking Sweden’s National Prostate Cancer Register with other nationwide databases and/or registries. Primary outcome measures of the study were the dispensation of antibiotics prescriptions for urinary-tract infections and hospitalization for urinary-tract infections. The authors used multivariable logistic regression to examine risk factors for infection in study participants.
In the 6 months prior to biopsy, the team reported, there was about a 2% incidence of urinary-tract infection in the men. Within 30 days after biopsy, 6% of the men had filled a prescription for urinary-tract antibiotics, and 1% were hospitalized with infection.
The strongest risk factors for being prescribed an antibiotic were prior infection (odds ratio [OR] 1.59, 95% CI 1.45-1.73), high Charlson comorbidity index (OR 1.25, 95% CI 1.11-1.41), and diabetes (OR 1.32, 95% CI 1.17-1.49). While the risk of an antibiotic prescription after biopsy decreased from 2006 to 2011 (OR 0.79, 95% CI 0.70-0.90), the risk of hospital admission increased (OR 2.14, 95% CI 1.58-2.94), the authors wrote.
No significant increase in 90-day mortality was detected, they reported.
“Severe infections with hospitalization after prostate biopsy are increasing in Sweden,” the authors concluded. “The risk of post-biopsy infection is highest in men with a history of urinary-tract infection and those with significant comorbidities.”
Lundström K-J, Drevin L, Carlsson S, et al. Nationwide Population Based Study of Infections after Transrectal Ultrasound Guided Prostate Biopsy. J Urol. Published online May 9, 2014. doi: 10.1016/j.juro.2014.04.098.