區域醫院經直腸超音波導引攝護腺切片感染好發生率及影響因素
方立仁、陳光國、王曉暹、謝啟誠、黃家倫、蔡昇翰、楊景偉、張心湜
振興醫療財團法人振興醫院 泌尿部
Infection after transrectal ultrasound-guided prostate biopsy -
rate and contributing factors at a regional hospital
Li-Ren Fang, Kuang-Kuo Chen, Hsiao-Hsian Wang, Chieh-Chen Hsieh,
Chia-Lun Huang, Sheng-han Tsai, Chin-Wei Yang, Luke S. Chang
Department of Urology, Cheng Hsin General Hospital

Purpose: To investigate the rate and contributing factors of infection following a transrectal ultrasound-guided prostate biopsy at a regional hospital.

Materials and Methods: A total of 160 patients received transrectal ultrasound-guided prostate biopsy; 17 under local anesthesia and 143 under spinal or general anesthesia. All patients were subjected to pre-biopsy rectal preparation (one or two EVAC enema) and prophylactic antibiotics. Post-biopsy antibiotics were also administered either intravenously and/or orally. The medical records were reviewed. The patients with fever (>38.5C), bacteriuria or bacteremia, and re-hospitalized within one week after prostate biopsy was defined as post-biopsy infection.

Results: There was a total of 7 patients (4.3%) suffered from post-biopsy infection. Of the 7 patients, 1 received local anesthesia; 6 received either spinal or general anesthesia. Four patients were given 2 Evac enemas, the other 3 were given 1 Evac enema. All seven patients received prophylactic antibiotics: four patients with a combination of intravenous cefazolin and gentamicin; the other three with a combination of intravenous cefazolin and gentamicin as well as oral ciprofloxacin. Of the 7 patients, 2 had positive blood culture, another 2 had positive urine culture and the other 3 had no bacteria growth on either blood or urine culture. No patient was reported to have both positive blood and urine cultures. In all cases with positive culture result, Escherichia coli was the only bacterium identified, though no resistant to either ciprofloxacin or carbapenem was found. Mean duration of re-hospitalization was 7.2 days. One patient was developed fever one day after his prostate biopsy and received an additional 5 days of antibiotics treatment. He was re-admitted 2 days later due to recurrent spiking fever.

Conclusions: A 4.3% (7/160) of post-biopsy infection rate was found at our hospital, as compared with national 6.59% infection rate tabulated over a 5-year span (between 2006 - 2010). The pre-biopsy administration of antibiotics and choice of anesthesia made no significant impact on the rate of infection. No patient was found to have both positive urine and blood culture. In the patients with either positive blood or urine culture, Escherichia coli was the only bacterium found.