Truls E Bjerklund Johansen1,2,3, Per-Henrik Zahl4, Eduard Baco5, Riccardo Bartoletti6, Gernot Bonkat7, Franck Bruyere8,9, Tommaso Cai10, Mete Cek11, Ekaterina Kulchavenya12, Bela Köves13, Vladimir Mouraviev14,15, Adrian Pilatz16, Zafer Tandogdu5,17, Peter Tenke13, Florian M E Wagenlehner16. 1. Department of Urology, Oslo University Hospital, Nydalen, Po. Box 4959, 0424, Oslo, Norway. tebj@medisin.uio.no. 2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. tebj@medisin.uio.no. 3. Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark. tebj@medisin.uio.no. 4. Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway. 5. Department of Urology, Oslo University Hospital, Nydalen, Po. Box 4959, 0424, Oslo, Norway. 6. Department of Urology, University of Pisa, Pisa, Italy. 7. Department of Urology, alta uro AG, Basel, Switzerland. 8. Urologie, 2 bd Tonnelle, 37044, Tours, France. 9. Université Francois Rabelais de Tours, PRES Centre val de Loire, 37044, Tours, France. 10. Department of Urology, Santa Chiara Hospital, Trento, Italy. 11. Department of Urology, Medical Faculty of Trakya University, Edirne, Turkey. 12. Urogenital Department, Novosibirsk Research TB Institute, 630040, Novosibirsk, Russian Federation. 13. South-Pest Teaching Hospital, Budapest, Hungary. 14. University of Central Florida, Orlando, FL, USA. 15. Central Florida Cancer Institute, Davenport, FL, USA. 16. Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany. 17. Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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.
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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