Increasing rates of urinary and bloodstream infections following transrectal prostate biopsy in South Sweden

OBJECTIVE: To report trends and characteristics of post‐prostate biopsy (PBx) infections, with regard to aetiology and resistance patterns, in a large unique cohort from a single‐centre using the same antibiotic prophylactic regimens during a 15‐year period. PATIENTS AND METHODS: An observational cross‐sectional cohort study, including all patients who underwent transrectal ultrasonography‐guided PBx (TRUS PBx) for the suspicion of prostate cancer at the Department of Urology, Skåne University Hospital between 1 May 2003 and 31 December 2017. Positive blood and urinary cultures were considered markers of bloodstream infection (BSI) and urinary tract infection (UTI), respectively. For all patients, details regarding blood or urine cultures from the date of the TRUS PBx and 14 days onwards were retrieved. RESULTS: In total, 8973 TRUS PBx procedures were performed in 6597 men during the study period. Over time, there was a trend towards a changing case‐mix, with PBx procedures increasingly being performed in older patients, patients with lower prostate‐specific antigen values, and higher prostate volumes. During the study period, the number of PBx procedures performed increased for each time period and we found an increasing rate of infectious complications in the last period. Overall, the rates of BSI and UTI with at least one relevant pathogen were 1% (88/8973) and 1.8% (159/8973), respectively. In total, 16 of 90 strains (18%) were extended spectrum beta‐lactamases producing, with an increasing proportion over time. The proportion of ciprofloxacin‐resistant pathogens did not increase over time. CONCLUSION: During the 15 years of this study, BSI and UTI after TRUS PBx increased. The rise of infectious complications after TRUS PBx in this population is unlikely to be explained by quinolone‐resistance, as ciprofloxacin‐resistance did not increase in the blood and urinary samples obtained during the study period. Future longitudinal studies are warranted to investigate why infectious complications after TRUS PBx are increasing.