Prevalence of Urinary Tract Infection and Urosepsis Following Transrectal Ultrasound-Guided Prostate Biopsy: Spectrum of Pathogens and Patterns of Antibiotic Resistance

TL;DR

This study found a low rate of infections after prostate biopsies in Pakistan, but high resistance to some antibiotics like ciprofloxacin.

Contribution

The study provides local data on infection rates and antibiotic resistance after prostate biopsies in Pakistan.

Findings

Only 2.68% of patients developed UTIs after the biopsy, with no cases of urosepsis.

E. coli was the most common pathogen, and ciprofloxacin resistance was notably high.

Fosfomycin showed the highest sensitivity among tested antibiotics.

Abstract

Introduction

Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) remains the global standard for diagnosing prostate cancer. Despite being a relatively safe procedure, it carries a risk of post-biopsy complications, most notably urinary tract infections (UTIs) and urosepsis. Increasing rates of antibiotic resistance, especially to fluoroquinolones, have raised concerns about the safety of TRUS-Bx in many regions. Data from Pakistan remain limited, prompting this study to investigate infectious complications and resistance profiles in a local tertiary care setting.

Objectives

This study aimed to determine the prevalence of UTIs and urosepsis following TRUS-Bx and to assess the spectrum of pathogens and antibiotic resistance patterns among affected patients.

Methods

This prospective descriptive cross-sectional study was conducted in the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, from November 3, 2021, to May 2, 2022. A total of 149 male patients aged 45-80 years with lower urinary tract symptoms, elevated prostate-specific antigen (PSA > 4 ng/mL), or palpable nodules on digital rectal examination were enrolled. Patients with uncontrolled diabetes mellitus, catheterization, bladder stones, pre-biopsy UTI, or positive urine culture were excluded. Pre-biopsy rectal swabs were obtained to guide targeted antimicrobial prophylaxis. Follow-up was performed on the seventh post-procedure day with complete blood count, urine culture, and blood culture irrespective of symptoms. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, NY, USA).

Results

Among 149 patients, four (2.68%) developed UTIs, while none developed urosepsis. Urine cultures revealed bacterial growth in 69 patients (46.3%), with Escherichia coli being the most frequent pathogen (24.2%). Sensitivity testing showed the highest susceptibility to fosfomycin (89.9%) and the lowest to ciprofloxacin (36.2%). Blood cultures were positive in 13 patients (8.7%), most commonly with coagulase-negative Staphylococcus (69.2%). Overall, infectious complication rates were lower than those reported in comparable international series, but resistance to ciprofloxacin was notable.

Conclusion

The prevalence of UTI and urosepsis following TRUS-Bx in this cohort was low. However, nearly half of the patients demonstrated bacterial colonization on urine culture, with E. coli as the leading pathogen and ciprofloxacin resistance as a significant concern. Fosfomycin demonstrated promising sensitivity and may be considered in prophylactic regimens. These findings highlight the need for ongoing surveillance of antimicrobial resistance and optimization of biopsy prophylaxis protocols in the local population.