A significant percentage of patients with transrectal biopsy-related infections have positive blood cultures but negative urine cultures. A literature review and meta-analysis

References

• Loeb S, Carter HB, Berndt SI, et al. Complications after prostate biopsy: data from SEER-Medicare. J Urol. 2011;186:1830–1834.
   PubMed Web of Science ®Google Scholar
• Williamson DA, Barrett LK, Rogers BA, et al. Infectious complications following transrectal ultrasound-guided prostate biopsy: new challenges in the era of multidrug-resistant Escherichia coli. Clin Infect Dis. 2013;57:267–274.
   PubMed Web of Science ®Google Scholar
• Bennett HY, Roberts MJ, Doi SAR, et al. The global burden of major infectious complications following prostate biopsy. Epidemiol Infect. 2016;144:1784–1791.
   PubMed Web of Science ®Google Scholar
• Karakonstantis S, Kalemaki D. Blood culture useful only in selected patients with urinary tract infections - a literature review. Infect Dis (Lond). 2018;50:584–592.
   Web of Science ®Google Scholar
• Etienne M, Pestel-Caron M, Chapuzet C, et al. Should blood cultures be performed for patients with acute prostatitis? J Clin Microbiol. 2010;48:1935–1938.
   PubMed Web of Science ®Google Scholar
• Smithson A, Chico C, Sanchez M, et al. Blood cultures for men with febrile urinary tract infection. J Clin Microbiol. 2010;48:2662–2663.
   PubMed Web of Science ®Google Scholar
• Lindert KA, Kabalin JN, Terris MK. Bacteremia and bacteriuria after transrectal ultrasound guided prostate biopsy. J Urol. 2000;164:76–80.
   PubMed Web of Science ®Google Scholar
• Liss MA, Johnson JR, Porter SB, et al. Clinical and microbiological determinants of infection after transrectal prostate biopsy. Clin Infect Dis. 2015;60:979–987.
   PubMed Web of Science ®Google Scholar
• Gottesman T, Yossepowich O, Harari-Schwartz O, et al. The value of rectal cultures in treatment of sepsis following post-transrectal ultrasound-guided prostate biopsy. Urol Int. 2015;95:177–182.
   PubMed Web of Science ®Google Scholar
• Kim JW, Oh MM, Bae JH, et al. Clinical and microbiological characteristics of spontaneous acute prostatitis and transrectal prostate biopsy-related acute prostatitis: istransrectal prostate biopsy-related acute prostatitis a distinct acute prostatitis category?. J Infect Chemother. 2015;21:434–437.
   PubMed Web of Science ®Google Scholar
• Dan M, Yair Y, Samosav A, et al. Escherichia coli isolates from patients with bacteremic urinary tract infection are genetically distinct from those derived from sepsis following prostate transrectal biopsy. Int J Med Microbiol. 2015;305:464–468.
   PubMed Web of Science ®Google Scholar
• van Nieuwkoop C, Bonten TN, Wout JW, et al. Risk factors for bacteremia with uropathogen not cultured from urine in adults with febrile urinary tract infection. Clin Infect Dis. 2010;50:e69–e72.
   PubMed Web of Science ®Google Scholar
• Spoorenberg V, Prins JM, Opmeer BC, et al. The additional value of blood cultures in patients with complicated urinary tract infections. Clin Microbiol Infect. 2014;20:O476–O479.
   PubMed Web of Science ®Google Scholar
• Kim Y, Seo MR, Kim SJ, et al. Usefulness of blood cultures and radiologic imaging studies in the management of patients with community-acquired acute pyelonephritis. Infect Chemother. 2017;49:22–30.
   PubMed Web of Science ®Google Scholar
• Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Bmj. 2009;339:b2700
   PubMed Web of Science ®Google Scholar
• Grummet JP, Weerakoon M, Huang S, et al. Sepsis and 'superbugs': should we favour the transperineal over the transrectal approach for prostate biopsy? BJU Int. 2014;114:384–388.
   PubMed Web of Science ®Google Scholar
• Grummet J, Pepdjonovic L, Moon D, et al. Complications after systematic, random, and image-guided prostate biopsy. Eur Urol. 2017;71:e143–e144.
   PubMed Web of Science ®Google Scholar
• Baba K, Sekine Y, Miyazawa Y, et al. Assessment of antimicrobiral prophylaxis in transperineal prostate biopsy: a single-center retrospective study of 485 cases. J Infect Chemother. 2018;24:637–640.
   PubMed Web of Science ®Google Scholar
• Eaton AC. The safety of transrectal biopsy of the prostate as an out-patient investigation. Br J Urol. 1981;53:144–146.
   PubMedGoogle Scholar
• Brown RW, Warner JJ, Turner BI, et al. Bacteremia and bacteriuria after transrectal prostatic biopsy. Urology. 1981;18:145–148.
   PubMed Web of Science ®Google Scholar
• Roach MB, Figueroa TE, McBride D, et al. Ciprofloxacin versus gentamicin in prophylaxis against bacteremia in transrectal prostate needle biopsy. Urology. 1991;38:84–87
   PubMed Web of Science ®Google Scholar
• Kanjanawongdeengam P, Viseshsindh W, Santanirand P, et al. Reduction in bacteremia rates after rectum sterilization before transrectal, ultrasound-guided prostate biopsy: a randomized controlled trial. J Med Assoc Thai. 2009;92:1621–1626.
   PubMedGoogle Scholar
• Egger M, Smith GD, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315:629–634.
   PubMed Web of Science ®Google Scholar
• Hunter JP, Saratzis A, Sutton AJ, et al. In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. J Clin Epidemiol. 2014;67:897–903.
   PubMed Web of Science ®Google Scholar
• Moreno SG, Sutton AJ, Ades A, et al. Assessment of regression-based methods to adjust for publication bias through a comprehensive simulation study. BMC Med Res Methodol. 2009;9:2.
   PubMed Web of Science ®Google Scholar
• Davison P, Malament M. Urinary contamination as a result of transrectal biopsy of the prostate. J Urol. 1971;105:545–546.
   PubMed Web of Science ®Google Scholar
• Lange D, Zappavigna C, Hamidizadeh R, et al. Bacterial sepsis after prostate biopsy–a new perspective. Urology. 2009;74:1200–1205.
   PubMed Web of Science ®Google Scholar
• Tal R, Livne PM, Lask DM, et al. Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy. J Urol. 2003;169:1762–1765.
   PubMed Web of Science ®Google Scholar
• Hedelin H, Claesson BE, Wilpart A. Febrile reactions after transrectal ultrasound-guided prostatic biopsy: a retrospective study. Scand J Urol Nephrol. 2011;45:393–396.
   PubMed Web of Science ®Google Scholar
• Mosharafa AA, Torky MH, El Said WM, et al. Rising incidence of acute prostatitis following prostate biopsy: fluoroquinolone resistance and exposure is a significant risk factor. Urology. 2011;78:511–514.
   PubMed Web of Science ®Google Scholar
• Chiang BJ, Pu YS, Chung SD, et al. Quinolone prophylaxis in transrectal ultrasound guided prostate biopsy: an eight-year single center experience. Scientific World J. 2013;2013:1.
   Google Scholar
• Tsai YS, Chen CH, Jou YC, et al. Febrile infection in post-prostate biopsy: results of a ten-year single-institution study in South Taiwan. Surg Infect. 2014;15:24–28.
   PubMed Web of Science ®Google Scholar
• Song W, Choo SH, Sung HH, et al. Incidence and management of extended-spectrum beta-lactamase and quinolone-resistant Escherichia coli infections after prostate biopsy. Urology. 2014;84:1001–1006.
   PubMed Web of Science ®Google Scholar
• Anderson E, Leahy O, Cheng AC, et al. Risk factors for infection following prostate biopsy - a case control study. BMC Infect Dis. 2015;15:580.
   PubMed Web of Science ®Google Scholar
• Sieber PR, Rommel FM, Agusta VE, et al. Antibiotic prophylaxis in ultrasound guided transrectal prostate biopsy. J Urol. 1997;157:2199–2200.
   PubMed Web of Science ®Google Scholar
• Shigehara K, Miyagi T, Nakashima T, et al. Acute bacterial prostatitis after transrectal prostate needle biopsy: clinical analysis. J Infect Chemother. 2008;14:40–43.
   PubMedGoogle Scholar
• Akduman B, Akduman D, Tokgoz H, et al. Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms. Urology. 2011;78:250–255.
   PubMed Web of Science ®Google Scholar
• Ismail M, Saini A, Nigam R. Ciprofloxacin-resistant infection after transrectal ultrasonography-guided prostate biopsy: should we reassess our practice?. BJU Int. 2011;108:305–306.
   PubMed Web of Science ®Google Scholar
• Ekici S, Cengiz M, Turan G, et al. Fluoroquinolone-resistant acute prostatitis requiring hospitalization after transrectal prostate biopsy: effect of previous fluoroquinolone use as prophylaxis or long-term treatment. Int Urol Nephrol. 2012;44:19–27.
   PubMed Web of Science ®Google Scholar
• Adibi M, Hornberger B, Bhat D, et al. Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic prophylaxis. J Urol. 2013;189:535–540.
   PubMed Web of Science ®Google Scholar
• Gopal Rao G, Batura D. Emergency hospital admissions attributable to infective complications of prostate biopsy despite appropriate prophylaxis: need for additional infection prevention strategies?. Int Urol Nephrol. 2014;46:309–315.
   PubMed Web of Science ®Google Scholar
• Luong B, Danforth T, Visnjevac O, et al. Reduction in hospital admissions with the addition of prophylactic intramuscular ceftriaxone before transrectal ultrasonography-guided prostate biopsies. Urology. 2015;85:511–516.
   PubMed Web of Science ®Google Scholar
• Miyazaki Y, Akamatsu S, Kanamaru S, et al. A prospective randomized trial comparing a combined regimen of amikacin and levofloxacin to levofloxacin alone as prophylaxis in transrectal prostate needle biopsy. Urol J. 2016;13:2533–2540.
   PubMed Web of Science ®Google Scholar
• Iwamoto H, Shigehara K, Miyagi T, et al. Efficacy of two-time prophylactic intravenous administration of tazobactam/piperacillin for transrectal ultrasound-guided needle biopsy of the prostate. Prostate Int. 2015;3:103–106.
   PubMed Web of Science ®Google Scholar
• Otrock ZK, Oghlakian GO, Salamoun MM, et al. Incidence of urinary tract infection following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon. Infect Control Hosp Epidemiol. 2004;25:873–877.
   PubMed Web of Science ®Google Scholar
• Hori S, Sengupta A, Joannides A, et al. Antibiotic prophylaxis for transrectal ultrasound-guided prostate biopsies: are we putting our patients at risk?. Eur Urol Supp. 2010;9:85–1302.
   Web of Science ®Google Scholar
• Samarinas M, Dimitropoulos K, Zachos I, et al. A single dose of meropenem is superior to ciprofloxacin in preventing infections after transrectal ultrasound-guided prostate biopsies in the era of quinolone resistance. World J Urol. 2016;34:1555–1559.
   PubMed Web of Science ®Google Scholar
• Farrell JJ, Hicks JL, Wallace SE, et al. Impact of preoperative screening for rectal colonization with fluoroquinolone-resistant enteric bacteria on the incidence of sepsis following transrectal ultrasound guided prostate biopsy. Rru. 2017;9:37–41.
   Google Scholar
• Unnikrishnan R, El-Shafei A, Klein EA, et al. For single dosing, levofloxacin is superior to ciprofloxacin when combined with an aminoglycoside in preventing severe infections after prostate biopsy. Urology. 2015;85:1241–1246.
   PubMedGoogle Scholar
• Ozden E, Bostanci Y, Yakupoglu KY, et al. Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy. Urology. 2009;74:119–123.
   PubMed Web of Science ®Google Scholar
• Bang JH, Choe HS, Lee DS, et al. Microbiological characteristics of acute prostatitis after transrectal prostate biopsy. Korean J Urol. 2013;54:117–122.
   PubMedGoogle Scholar
• Campeggi A, Ouzaid I, Xylinas E, et al. Acute bacterial prostatitis after transrectal ultrasound-guided prostate biopsy: epidemiological, bacteria and treatment patterns from a 4-year prospective study. Int J Urol. 2014;21:152–155.
   PubMed Web of Science ®Google Scholar
• Roberts MJ, Bennett HY, Harris PN, et al. Prostate biopsy-related infection: a systematic review of risk factors, prevention strategies, and management approaches. Urology. 2017;104:11–21.
   PubMed Web of Science ®Google Scholar
• Gyorfi JR, Otteni C, Brown K, et al. Peri-procedural povidone-iodine rectal preparation reduces microorganism counts and infectious complications following ultrasound-guided needle biopsy of the prostate. World J Urol. 2014;32:905–909.
   PubMed Web of Science ®Google Scholar
• Hayatzaki K, Menne S, Nielsen K. Prophylactic antibiotics reduce sepsis after biopsy of the prostate. Dan Med J. 2014;61:A4963
   PubMed Web of Science ®Google Scholar
• Batura D, Rao GG, Bo Nielsen P, et al. Adding amikacin to fluoroquinolone-based antimicrobial prophylaxis reduces prostate biopsy infection rates. BJU Int. 2011;107:760–764.
   PubMed Web of Science ®Google Scholar
• Zaytoun OM, Vargo EH, Rajan R, et al. Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment. Urology. 2011;77:1035–1041.
   PubMed Web of Science ®Google Scholar
• Patel U, Dasgupta P, Amoroso P, et al. Infection after transrectal ultrasonography-guided prostate biopsy: increased relative risks after recent international travel or antibiotic use. BJU Int. 2012;109:1781–1785.
   PubMedGoogle Scholar
• Pu C, Bai Y, Yuan H, et al. Reducing the risk of infection for transrectal prostate biopsy with povidone-iodine: a systematic review and meta-analysis. Int Urol Nephrol. 2014;46:1691–1698.
   PubMed Web of Science ®Google Scholar
• IntHout J, Ioannidis JPA, Borm GF, et al. Small studies are more heterogeneous than large ones: a meta-meta-analysis. J Clin Epidemiol. 2015;68:860–869.
   PubMed Web of Science ®Google Scholar
• von Hippel PT. The heterogeneity statistic I(2) can be biased in small meta-analyses. BMC Med Res Methodol. 2015;15:35.
   PubMed Web of Science ®Google Scholar
• Groenwold RHH, Rovers MM, Lubsen J, et al. Subgroup effects despite homogeneous heterogeneity test results. BMC Med Res Methodol. 2010;10:43.
   PubMed Web of Science ®Google Scholar
• Heytens S, De Sutter A, Coorevits L, et al. Women with symptoms of a urinary tract infection but a negative urine culture: PCR-based quantification of Escherichia coli suggests infection in most cases. Clin Microbiol Infect. 2017;23:647–652.
   PubMed Web of Science ®Google Scholar
• Lee A, Mirrett S, Reller LB, et al. Detection of bloodstream infections in adults: how many blood cultures are needed?. J Clin Microbiol. 2007;45:3546–3548.
   PubMed Web of Science ®Google Scholar
• Huang YC, Ho DR, Wu CF, et al. Modified bowel preparation to reduce infection after prostate biopsy. Chang Gung Med J. 2006;29:395–400.
   PubMedGoogle Scholar
• Tuncel A, Aslan Y, Sezgin T, et al. Does disposable needle guide minimize infectious complications after transrectal prostate needle biopsy? Urology. 2008;71:1024–1027
   PubMed Web of Science ®Google Scholar
• Loeb S, van den Heuvel S, Zhu X, et al. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol. 2012;61:1110–1114.
   PubMed Web of Science ®Google Scholar
• Manecksha RP, Nason GJ, Cullen IM, et al. Prospective study of antibiotic prophylaxis for prostate biopsy involving >1100 men. Scientific World J. 2012;2012:1.
   Google Scholar
• Lorber G, Benenson S, Rosenberg S, et al. A single dose of 240 mg gentamicin during transrectal prostate biopsy significantly reduces septic complications. Urology. 2013;82:998–1003.
   PubMed Web of Science ®Google Scholar
• Losco G, Studd R, Blackmore T. Ertapenem prophylaxis reduces sepsis after transrectal biopsy of the prostate. BJU Int. 2014;113 Suppl 2:69–72.
   PubMed Web of Science ®Google Scholar
• Rudzinski JK, Kawakami J. Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: a retrospective population-based analysis. Can Cuaj. 2014;8:E301–E305.
   Google Scholar
• Dai J, Leone A, Mermel L, et al. Rectal swab culture-directed antimicrobial prophylaxis for prostate biopsy and risk of postprocedure infection: a cohort study. Urology. 2015;85:8–14.
   PubMed Web of Science ®Google Scholar
• Trujillo CG, Plata M, Caicedo JI, et al. Impact of rectal swabs on infectious complications after transrectal prostate biopsy. Urol Int. 2016;97:340–346.
   PubMed Web of Science ®Google Scholar