Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy

first report from the Norwegian Patient Registry

Truls E.Bjerklund Johansen, Per Henrik Zahl, Eduard Baco, Riccardo Bartoletti, Gernot Bonkat, Franck Bruyere, Tommaso Cai, Mete Cek, Ekaterina Kulchavenya, Bela Köves, Vladimir Mouraviev, Adrian Pilatz, Zafer Tandogdu, P. Tenke, Florian M.E. Wagenlehner

Research output: Review article

Abstract

Background: A 68-year-old man died of cerebral arterial embolism 6 days after transrectal prostate biopsy with a single p.o. dose of trimethoprim sulfamethoxazole (TMP-SMX) as prophylaxis. The case precipitated analysis of local antibiotic resistance and complication rates. Materials and methods: Data on E. coli resistance from Oslo University Hospital and national data on hospitalizations and mortality after biopsy were retrieved from local microbiology files and the Norwegian Patient Registry (NPR) 2011–2017. Results: Urine E. coli resistance against TMP-SMX increased from 35% in 2013 to more than 60% in 2015. For ciprofloxacin, the resistance increased from 15% in 2013 to about 45% in 2016. The highest annual E. coli resistance in blood cultures for TMP-SMX and ciprofloxacin was 37% and 28%, respectively. 10% of patients were hospitalized with a diagnosis of infection within the first 60 days after biopsy and there was a relative increase in mortality rate of 261% within the first 30 days. Due to the severity of the figures, the story and the NPR data were published in Norway’s leading newspaper and were succeeded by a series of chronicles and commentaries. Conclusions: Several critical points of the biopsy procedure were not performed according to current standards. We believe that the patient might have died of septic embolism after biopsy. As a result of the findings and the debate, local practice was changed from transrectal to transperineal prostate biopsies.

Original languageEnglish
JournalWorld Journal of Urology
DOIs
Publication statusPublished - jan. 1 2019

Fingerprint

Microbial Drug Resistance
Registries
Prostate
Hospitalization
Biopsy
Mortality
Sulfamethoxazole Drug Combination Trimethoprim
Ciprofloxacin
Escherichia coli
Intracranial Embolism
Newspapers
Norway
Microbiology
Embolism
Urine
Infection

ASJC Scopus subject areas

  • Urology

Cite this

Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy : first report from the Norwegian Patient Registry. / Johansen, Truls E.Bjerklund; Zahl, Per Henrik; Baco, Eduard; Bartoletti, Riccardo; Bonkat, Gernot; Bruyere, Franck; Cai, Tommaso; Cek, Mete; Kulchavenya, Ekaterina; Köves, Bela; Mouraviev, Vladimir; Pilatz, Adrian; Tandogdu, Zafer; Tenke, P.; Wagenlehner, Florian M.E.

In: World Journal of Urology, 01.01.2019.

Research output: Review article

Johansen, TEB, Zahl, PH, Baco, E, Bartoletti, R, Bonkat, G, Bruyere, F, Cai, T, Cek, M, Kulchavenya, E, Köves, B, Mouraviev, V, Pilatz, A, Tandogdu, Z, Tenke, P & Wagenlehner, FME 2019, 'Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy: first report from the Norwegian Patient Registry', World Journal of Urology. https://doi.org/10.1007/s00345-019-02837-0
Johansen, Truls E.Bjerklund ; Zahl, Per Henrik ; Baco, Eduard ; Bartoletti, Riccardo ; Bonkat, Gernot ; Bruyere, Franck ; Cai, Tommaso ; Cek, Mete ; Kulchavenya, Ekaterina ; Köves, Bela ; Mouraviev, Vladimir ; Pilatz, Adrian ; Tandogdu, Zafer ; Tenke, P. ; Wagenlehner, Florian M.E. / Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy : first report from the Norwegian Patient Registry. In: World Journal of Urology. 2019.
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abstract = "Background: A 68-year-old man died of cerebral arterial embolism 6 days after transrectal prostate biopsy with a single p.o. dose of trimethoprim sulfamethoxazole (TMP-SMX) as prophylaxis. The case precipitated analysis of local antibiotic resistance and complication rates. Materials and methods: Data on E. coli resistance from Oslo University Hospital and national data on hospitalizations and mortality after biopsy were retrieved from local microbiology files and the Norwegian Patient Registry (NPR) 2011–2017. Results: Urine E. coli resistance against TMP-SMX increased from 35{\%} in 2013 to more than 60{\%} in 2015. For ciprofloxacin, the resistance increased from 15{\%} in 2013 to about 45{\%} in 2016. The highest annual E. coli resistance in blood cultures for TMP-SMX and ciprofloxacin was 37{\%} and 28{\%}, respectively. 10{\%} of patients were hospitalized with a diagnosis of infection within the first 60 days after biopsy and there was a relative increase in mortality rate of 261{\%} within the first 30 days. Due to the severity of the figures, the story and the NPR data were published in Norway’s leading newspaper and were succeeded by a series of chronicles and commentaries. Conclusions: Several critical points of the biopsy procedure were not performed according to current standards. We believe that the patient might have died of septic embolism after biopsy. As a result of the findings and the debate, local practice was changed from transrectal to transperineal prostate biopsies.",
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T1 - Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy

T2 - first report from the Norwegian Patient Registry

AU - Johansen, Truls E.Bjerklund

AU - Zahl, Per Henrik

AU - Baco, Eduard

AU - Bartoletti, Riccardo

AU - Bonkat, Gernot

AU - Bruyere, Franck

AU - Cai, Tommaso

AU - Cek, Mete

AU - Kulchavenya, Ekaterina

AU - Köves, Bela

AU - Mouraviev, Vladimir

AU - Pilatz, Adrian

AU - Tandogdu, Zafer

AU - Tenke, P.

AU - Wagenlehner, Florian M.E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: A 68-year-old man died of cerebral arterial embolism 6 days after transrectal prostate biopsy with a single p.o. dose of trimethoprim sulfamethoxazole (TMP-SMX) as prophylaxis. The case precipitated analysis of local antibiotic resistance and complication rates. Materials and methods: Data on E. coli resistance from Oslo University Hospital and national data on hospitalizations and mortality after biopsy were retrieved from local microbiology files and the Norwegian Patient Registry (NPR) 2011–2017. Results: Urine E. coli resistance against TMP-SMX increased from 35% in 2013 to more than 60% in 2015. For ciprofloxacin, the resistance increased from 15% in 2013 to about 45% in 2016. The highest annual E. coli resistance in blood cultures for TMP-SMX and ciprofloxacin was 37% and 28%, respectively. 10% of patients were hospitalized with a diagnosis of infection within the first 60 days after biopsy and there was a relative increase in mortality rate of 261% within the first 30 days. Due to the severity of the figures, the story and the NPR data were published in Norway’s leading newspaper and were succeeded by a series of chronicles and commentaries. Conclusions: Several critical points of the biopsy procedure were not performed according to current standards. We believe that the patient might have died of septic embolism after biopsy. As a result of the findings and the debate, local practice was changed from transrectal to transperineal prostate biopsies.

AB - Background: A 68-year-old man died of cerebral arterial embolism 6 days after transrectal prostate biopsy with a single p.o. dose of trimethoprim sulfamethoxazole (TMP-SMX) as prophylaxis. The case precipitated analysis of local antibiotic resistance and complication rates. Materials and methods: Data on E. coli resistance from Oslo University Hospital and national data on hospitalizations and mortality after biopsy were retrieved from local microbiology files and the Norwegian Patient Registry (NPR) 2011–2017. Results: Urine E. coli resistance against TMP-SMX increased from 35% in 2013 to more than 60% in 2015. For ciprofloxacin, the resistance increased from 15% in 2013 to about 45% in 2016. The highest annual E. coli resistance in blood cultures for TMP-SMX and ciprofloxacin was 37% and 28%, respectively. 10% of patients were hospitalized with a diagnosis of infection within the first 60 days after biopsy and there was a relative increase in mortality rate of 261% within the first 30 days. Due to the severity of the figures, the story and the NPR data were published in Norway’s leading newspaper and were succeeded by a series of chronicles and commentaries. Conclusions: Several critical points of the biopsy procedure were not performed according to current standards. We believe that the patient might have died of septic embolism after biopsy. As a result of the findings and the debate, local practice was changed from transrectal to transperineal prostate biopsies.

KW - Antibiotic resistance

KW - Complications

KW - Death

KW - Hospitalization

KW - Prostate biopsy

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SN - 0724-4983

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