Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Clinical Research

Formalin disinfection of prostate biopsy needles may reduce post-biopsy infectious complications

Abstract

Background:

We sought to determine whether formalin disinfection of prostate biopsy needles between cores reduces post-biopsy urinary tract infections (UTIs).

Methods:

We reviewed a single-surgeon experience of transrectal prostate biopsies from 2010 to 2014. Biopsies were performed in either an operative suite, where 10% formalin was used to disinfect the needle tip between each biopsy core, or an outpatient clinic, where formalin was not used. Our primary outcome was post-biopsy UTI rates, defined as a positive urine culture within 30 days of biopsy. Infection severity was characterized by the need for admission. Patient demographics, prostate size, prior biopsies, prior UTIs, pre-biopsy antibiotics and cultures and post-biopsy cultures were analyzed. Logistic regression was used to assess predictors of post-biopsy UTIs. Statistical significance was defined as P<0.05.

Results:

A total of 756 patients were included for analysis, including 253 who received formalin disinfection and 503 who did not. Of these, 32 patients (4.2%) experienced post-biopsy UTIs, with 8 requiring admission (all without formalin use). Infection rates were more than double in the group that did not receive formalin (5.2% vs 2.3%, P=0.085). More patients in the formalin group had undergone prior biopsies (73.9% vs 31.8%, P<0.001). On multivariable analysis, prior UTI (odds ratio (OR) 3.77, P=0.006) was a significant predictor for post-biopsy infection, whereas formalin disinfection trended towards a protective effect (OR 0.41, P=0.055).

Conclusion:

Infectious complications following prostate biopsy may be mitigated by the use of formalin disinfection of the biopsy needle between cores.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

References

  1. Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R et al. Systematic review of complications of prostate biopsy. Eur Urol 2013; 64: 876–892.

    Article  Google Scholar 

  2. Liss MA, Chang A, Santos R, Nakama-Peeples A, Peterson EM, Osann K et al. Prevalence and significance of fluoroquinolone resistant Escherichia coli in patients undergoing transrectal ultrasound guided prostate needle biopsy. J Urol 2011; 185: 1283–1288.

    Article  Google Scholar 

  3. Feliciano J, Teper E, Ferrandino M, Macchia RJ, Blank W, Grunberger I et al. The incidence of fluoroquinolone resistant infections after prostate biopsy—are fluoroquinolones still effective prophylaxis? J Urol 2008; 179: 952–955discussion 5.

    Article  Google Scholar 

  4. Patel U, Kirby R . Infections after prostate biopsy and antibiotic resistance. BJU Int 2008; 101: 1201–1202.

    Article  Google Scholar 

  5. Sieber PR, Rommel FM, Agusta VE, Breslin JA, Huffnagle HW, Harpster LE . Antibiotic prophylaxis in ultrasound guided transrectal prostate biopsy. J Urol 1997; 157: 2199–2200.

    Article  CAS  Google Scholar 

  6. Tal R, Livne PM, Lask DM, Baniel J . Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy. J Urol 2003; 169: 1762–1765.

    Article  Google Scholar 

  7. Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH et al. Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostatebiopsy. J Urol 2013; 189 (1 Suppl): S12–S17 discussion S7-8.

    PubMed  Google Scholar 

  8. Adibi M, Pearle MS, Lotan Y . Cost-effectiveness of standard vs intensive antibiotic regimens for transrectal ultrasonography (TRUS)-guided prostate biopsy prophylaxis. BJU Int 2012; 110 (2 Pt 2): E86–E91.

    Article  Google Scholar 

  9. Adibi M, Hornberger B, Bhat D, Raj G, Roehrborn CG, Lotan Y . Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic prophylaxis. J Urol 2013; 189: 535–540.

    Article  Google Scholar 

  10. Batura D, Rao GG, Bo Nielsen P, Charlett A . Adding amikacin to fluoroquinolone-based antimicrobial prophylaxis reduces prostate biopsy infection rates. BJU Int 2011; 107: 760–764.

    Article  Google Scholar 

  11. Ho HS, Ng LG, Tan YH, Yeo M, Cheng CW . Intramuscular gentamicin improves the efficacy of ciprofloxacin as an antibiotic prophylaxis for transrectal prostate biopsy. Ann Acad Med Singapore 2009; 38: 212–216.

    PubMed  Google Scholar 

  12. Kehinde EO, Al-Maghrebi M, Sheikh M, Anim JT . Combined ciprofloxacin and amikacin prophylaxis in the prevention of septicemia after transrectal ultrasound guided biopsy of the prostate. J Urol 2013; 189: 911–915.

    Article  CAS  Google Scholar 

  13. Duplessis CA, Bavaro M, Simons MP, Marguet C, Santomauro M, Auge B et al. Rectal cultures before transrectal ultrasound-guided prostate biopsy reduce post-prostatic biopsy infection rates. Urology 2012; 79: 556–561.

    Article  Google Scholar 

  14. Pearle MS . Should we change our prophylactic antimicrobial regimen for prostate biopsy? J Urol 2011; 185: 1181–1183.

    Article  Google Scholar 

  15. Steensels D, Slabbaert K, De Wever L, Vermeersch P, Van Poppel H, Verhaegen J . Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy—should we reassess our practices for antibiotic prophylaxis? Clin Microbiol Infect 2012; 18: 575–581.

    Article  CAS  Google Scholar 

  16. Taylor AK, Zembower TR, Nadler RB, Scheetz MH, Cashy JP, Bowen D et al. Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol 2012; 187: 1275–1279.

    Article  CAS  Google Scholar 

  17. Horcajada JP, Busto M, Grau S, Sorli L, Terradas R, Salvado M et al. High prevalence of extended-spectrum beta-lactamase-producing enterobacteriaceae in bacteremia after transrectal ultrasound-guided prostate biopsy: a need for changing preventive protocol. Urology 2009; 74: 1195–1199.

    Article  Google Scholar 

  18. Abughosh Z, Margolick J, Goldenberg SL, Taylor SA, Afshar K, Bell R et al. A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy. J Urol 2013; 189: 1326–1331.

    Article  CAS  Google Scholar 

  19. Gil-Vernet Sedo JM, Alvarez-Vijande Garcia R . Effect of intrarectal povidone-iodine in the incidence of infectious complications after transrectal prostatic biopsy. Arch Esp Urol 2012; 65: 463–466.

    PubMed  Google Scholar 

  20. Carey JM, Korman HJ . Transrectal ultrasound guided biopsy of the prostate. Do enemas decrease clinically significant complications? J Urol 2001; 166: 82–85.

    Article  CAS  Google Scholar 

  21. Zani EL, Clark OA, Rodrigues Netto N Jr . Antibiotic prophylaxis for transrectal prostate biopsy. Cochrane Database Syst Rev 2011; (5): CD006576.

    Google Scholar 

  22. Zaytoun OM, Anil T, Moussa AS, Jianbo L, Fareed K, Jones JS . Morbidity of prostate biopsy after simplified versus complex preparation protocols: assessment of risk factors. Urology 2011; 77: 910–914.

    Article  Google Scholar 

  23. Jeon SS, Woo SH, Hyun JH, Choi HY, Chai SE . Bisacodyl rectal preparation can decrease infectious complications of transrectal ultrasound-guided prostatebiopsy. Urology 2003; 62: 461–466.

    Article  Google Scholar 

  24. Issa MM, Al-Qassab UA, Hall J, Ritenour CW, Petros JA, Sullivan JW . Formalin disinfection of biopsy needle minimizes the risk of sepsis following prostatebiopsy. J Urol 2013; 190: 1769–1775.

    Article  Google Scholar 

  25. United States Environmental Protection Agency. 2012 Edition of the Drinking Water Standards and Health Advisories. April 2012. Available at http://water.epa.gov/action/advisories/drinking/upload/dwstandards2012.pdf. Accessed 23 December 2015. EPA Publication 822-S-12-001.

  26. Grafstrom RC, Fornace A Jr, Harris CC . Repair of DNA damage caused by formaldehyde in human cells. Cancer Res 1984; 44: 4323–4327.

    CAS  PubMed  Google Scholar 

  27. International Programme on Chemical Safety (IPCS). Formaldehyde. World Health Organization: Geneva. (Environmental Health Criteria, No 89). 1989.

  28. Howard PH. Handbook of Environmental Fate and Exposure Data for Organic Chemicals. Lewis Publishers: Chelsea, MI 1989; pp 1–5.

  29. El-Naggar MY, Akeila MA, Turk HA, El-Ebady AA, Sahaly MZ . Evaluation of in vitro antibacterial activity of some disinfectants on Escherichia coli serotypes. J Gen Appl Microbiol 2001; 47: 63–73.

    Article  CAS  Google Scholar 

  30. Akduman B, Akduman D, Tokgoz H, Erol B, Turker T, Ayoglu F et al. Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms. Urology 2011; 78: 250–255.

    Article  Google Scholar 

  31. Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schroder FH, Roobol MJ . Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 2012; 61: 1110–1114.

    Article  Google Scholar 

  32. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM . Is repeat prostate biopsy associated with a greater risk of hospitalization? Data from SEER-Medicare. J Urol 2013; 189: 867–870.

    Article  Google Scholar 

  33. Berger AP, Gozzi C, Steiner H, Frauscher F, Varkarakis J, Rogatsch H et al. Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. J Urol 2004; 171: 1478–1480discussion 80-1.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C G Roehrborn.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singla, N., Walker, J., Woldu, S. et al. Formalin disinfection of prostate biopsy needles may reduce post-biopsy infectious complications. Prostate Cancer Prostatic Dis 20, 216–220 (2017). https://doi.org/10.1038/pcan.2016.70

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/pcan.2016.70

Search

Quick links