Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy

Purpose: Although urinary tract infection is a recognized complication of transrectal ultrasound guided prostate biopsy, to our knowledge there are no recommendations in the literature for its management. We studied the unique features of this infection and provide management recommendations. Materials and Methods: A prospective design was used. The study group was composed of patients admitted to the emergency department from 2000 to 2001 with complaints suggestive of urinary tract infection after transrectal ultrasound guided prostate biopsy. The indication for biopsy, prophylactic regimen used and clinical manifestations were documented. Urine and blood cultures were obtained at hospital admission and bacterial susceptibility was examined for all positive cultures. Results: All 23 patients enrolled in the study underwent biopsy for acceptable indications and 95.7% had received antibiotic prophylaxis, including 69.5% with fluoroquinolones. Infection was typically accompanied by high fever (mean ± SD 39.1 ± 0.6C), chills in 78.3% of cases and leukocytosis in 56.5%. All positive blood cultures and 92.9% of positive urine cultures yielded Escherichia coli. Bacterial isolates showed high resistance to fluoroquinolones and trimethoprimsulfamethoxazole, and 100% susceptibility to second and third generation cephalosporins, amikacin and carbapenems. Conclusions: The successful management of urinary tract infection complicating transrectal prostate biopsy depends on the recognition of its unique features, the pathogens involved and their antimicrobial susceptibility. The recommended empirical treatment is a second or third generation cephalosporin, amikacin or a carbapenem.