OBJECTIVE

There is concern over literature reports of rising rates of TRUS biopsy sepsis and multi-resistant bacteria in rectal flora, including new strains of carbapenem-resistant Enterobacter (CRE). TRUS biopsy sepsis can cause serious morbidity and even mortality. We sought to determine the number of hospital re-admissions for sepsis following TRUS biopsy and the rate of both prophylactic and therapeutic use of carbapenem antibiotics over the last 4 years in a single institution.

METHODS

Following ethical approval by the IRB, the Cabrini Health Medical Records Department computer database was queried for coding of admissions under any urologist for sepsis and prostate-related infections over 4 years from 2009 to 2012. These records were then examined for whether a TRUS biopsy had been performed at Cabrini Health within 7 days prior. The rate of carbapenem use for treatment was also assessed. Over the same time period, the database was also queried for patients undergoing TRUS biopsy at Cabrini Health and matched to orders for the supply of a carbapenem for prophylaxis at the time of biopsy.

RESULTS

Over the 4 years studied, 1,937 patients underwent a TRUS biopsy at Cabrini Health. There were 23 re-admissions for TRUS biopsy sepsis at Cabrini Health (1.2%). Ten (43.5%) of these patients received intravenous carbapenem as part of their sepsis treatment. None of them had received a carbapenem as prophylaxis. Of the 1,937 patients, 154 (8%) were given a carbapenem as prophylaxis, with significant increase in use over each of the 4 years studied (1, 21, 59, 73 respectively) from 2009 to 2012.

CONCLUSIONS

Despite recent literature reports, these local data did not show evidence of an increasing rate of TRUS biopsy sepsis at this single institution. However, there was a dramatic uptake in the use of broad-spectrum carbapenems for prophylaxis over the last 4 years. This highlights urologists’ concern over increasingly prevalent multi-resistant bacteria. The increase in carbapenem use is itself a concern also, as these antibiotics are currently the last line of defence against such bacteria. An alternative approach to prostate biopsy that avoids rectal flora altogether, such as transperineal biopsy, may be required to avert this serious and rapidly evolving problem.