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EXIT from TRansrectal prostate biopsies (TREXIT): sepsis rates of transrectal biopsy with rectal swab culture guided antimicrobials versus freehand transperineal biopsy

Prostate Cancer and Prostatic Diseases volume 25, pages 283–287 (2022)Cite this article

Subjects

Abstract

Background

Transrectal prostate biopsy (TRUSBx) holds a risk of prostate biopsy related sepsis. We discuss our step-wise strategies aiming to reduce this risk, including targeted antimicrobials and switching to a freehand transperineal approach (FHTPBx).

Subjects and methods

This longitudinal cohort study included three groups. Group A underwent TRUSBx with empirical augmented antimicrobial prophylaxis; Group B underwent TRUSBx with targeted antimicrobial prophylaxis, based on rectal-swab cultures/sensitivity; Group C underwent FHTPBx with empirical antimicrobial prophylaxis. Post biopsy sepsis, defined according to the surviving sepsis campaign and confirmed with blood or urinary cultures, were determined and rates between groups were analysed using fisher’s exact test.

Results

Of all 1501 patients, 23 developed post biopsy sepsis; Group A (12/609, 2.0%), B (9/403, 2.2%), C (2/489, 0.4%). Targeted antimicrobials did not reduce the risk of post biopsy sepsis following TRUSBx (A vs B, 2.0% vs 2.2%; p = 0.82). Patients with antimicrobial-resistant rectal flora had an increased post biopsy sepsis rate following TRUSBx despite targeted antimicrobials (9.1% vs 1.1%, p = 0.003). Switching to FHTPBx reduced the risk of developing post biopsy sepsis (A vs C, 2% vs 0.4%, p = 0.03; B vs C, 2.2% vs 0.4%, p = 0.03).

Conclusions

Targeted antimicrobials based on rectal swab culture failed to reduce the overall risk of post biopsy sepsis, while FHTPBx nearly eliminated this risk. We recommend the use of transperineal prostate biopsies for all patients as the most effective method to reduce the risk of sepsis.

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Fig. 1: Group sizes and antimicrobial prophylactic regimens.

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Author information

Authors and Affiliations

  1. Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK

    Thomas Hedley Newman, Luke Stroman, Marios Hadjipavlou, Arman Haque, Jonah Rusere, Kimberley Chan, Demetris Ioannides, Antonina Di Benedetto, Tibor Pinczes & Mohamed Y. Hammadeh

  2. Guy’s and St Thomas’ NHS trust, Guy’s Hospital, Great Maze Pond, London, UK

    Rick Popert

Authors
  1. Thomas Hedley Newman
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  2. Luke Stroman
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  3. Marios Hadjipavlou
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Contributions

THN contributed to all aspects of the study, most notably data collection, data analysis and writing the manuscript. LS contributed to all aspects of the study and helped write the manuscript. MH carried out the original study and supported all aspect of this study. AH performed data collection and reviewed the manuscript. JR trained the department to perform prostate biopsies and reviewed the manuscript. KC performed data collection and reviewed the manuscript. DI performed data collection and reviewed the manuscript. ADB supported training, performed biopsies, supported data collection, and reviewed the manuscript. TP performed biopsies, supported data collection, and reviewed the manuscript. RP was the second supervisor, trained clinicians to perform biopsies and reviewed the manuscript. MYH was the principal supervisor and contributed to all aspects of the study.

Corresponding author

Correspondence to Thomas Hedley Newman.

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Competing interests

RP: The NHS Innovation Accelerator Bursary; honoraria BXT Accelyon for teaching and training; professional services agreement HCA International; honoraria for Johanssen for teaching. All other authors declare no competing interests.

Ethics approval

The study was formally approved by the local clinical audit committee with consultation from local microbiology committee.

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Newman, T.H., Stroman, L., Hadjipavlou, M. et al. EXIT from TRansrectal prostate biopsies (TREXIT): sepsis rates of transrectal biopsy with rectal swab culture guided antimicrobials versus freehand transperineal biopsy. Prostate Cancer Prostatic Dis 25, 283–287 (2022). https://doi.org/10.1038/s41391-021-00438-w

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