Clinical Value of a Routine Urine Culture Prior to Transrectal Prostate Biopsy

Joakim Örtegren; Anna Wimmerstedt; Daniel Åberg; Håkan Janson; Henrik Kjölhede; Gunnar Kahlmeter; Ola Bratt

doi:10.1016/j.euros.2022.11.024

Clinical Value of a Routine Urine Culture Prior to Transrectal Prostate Biopsy

Eur Urol Open Sci. 2022 Dec 26:48:54-59. doi: 10.1016/j.euros.2022.11.024. eCollection 2023 Feb.

Authors

Joakim Örtegren^{1

2}, Anna Wimmerstedt³, Daniel Åberg⁴, Håkan Janson⁵, Henrik Kjölhede^{1

6}, Gunnar Kahlmeter⁵, Ola Bratt^{1

6}

Affiliations

¹ Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
² Section of Urology, Department of Surgery, Region Kronoberg, Växjö, Sweden.
³ Department of Infectious Diseases, Region Värmland, Karlstad, Sweden.
⁴ Regional Office, Region Kronoberg, Växjö, Sweden.
⁵ Department of Clinical Microbiology, Region Kronoberg, Växjö, Sweden.
⁶ Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.

Abstract

Background: Infectious complications after a transrectal prostate biopsy may be severe. In Sweden, a routine culture prior to all prostate biopsies was introduced to enable targeted antimicrobial prophylaxis and reduce postbiopsy infections.

Objective: To investigate whether a clinical routine with a urine culture prior to a prostate biopsy and targeted prophylactic antibiotic therapy reduces postbiopsy infections.

Design setting and participants: In 2015, a site-specific antimicrobial stewardship programme with a urine culture prior to a prostate biopsy was initiated in Region Kronoberg. To evaluate this routine, we designed a population-based register study including all men who had an outpatient prostate biopsy in 2015-2019 and a control period including all men who had a biopsy in 2010-2014, when a urinary culture was obtained only on clinical suspicion.

Outcome measurements and statistical analysis: The primary outcome was infectious complications within 10 d and the secondary outcome was a change in antibiotic prophylactic treatment. An infectious complication was defined as prescription of antibiotics for urinary tract infections or admission to hospital for urinary tract infections or sepsis after a biopsy.

Results and limitations: The urine culture period included 2971 prostate biopsy procedures, of which 2684 (90%) were preceded by a urine culture. The control period included 2818 procedures, of which 135 (4.8%) were preceded by a urine culture. Infectious complications were slightly more common during the urine culture period (5.0%) than during the control period (4.3%, p = 0.17), as was inpatient care for infections (3.5% vs 2.2%, p = 0.002). The routine identified 5.4% men with asymptomatic bacteriuria. Despite targeted antibiotic treatment (1.5% received a nonfluoroquinolone treatment), the rate of infectious complications (6.3%) was similar to that in the control period.

Conclusions: Prebiopsy urine culture did not lead to fewer postbiopsy infections. Other measures are needed to reduce infectious complications after a prostate biopsy.

Patient summary: In this report, we evaluated a routine with urine culture prior to a transrectal prostate biopsy and found that it did not lead to fewer infectious complications.

Keywords: Antibiotic resistance; Biopsy; Infection; Prostate; Urine culture.