Infection rates following prostate biopsy have remained stable since 2007, but visits to emergency departments and hospital and intensive care unit (ICU) admissions for post-biopsy infections continue to increase, according to a new study. Use of targeted prophylaxis remains limited.

Investigators led by Jim C. Hu, MD, of New York Presbyterian Hospital, Weill Cornell Medical College, New York, used 2001 to 2015 data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to examine 30-day infection rates and emergency department visits and hospital and ICU admissions for infection following prostate biopsy. The study included 274,858 biopsies. At the time of biopsy, patients had a mean age of 74 years.

The overall rate of post-biopsy infections increased from 5.9% in 2001 to 7.2% in 2007, but remained stable through 2015, Dr Hu and his colleagues reported in Urology. Still, from 2001 to 2015, the rate of emergency department visits for post-biopsy infections increased from 0.2% to 0.5%. The rate of hospital admissions increased from 0.5% to 1.3%, and the rate of ICU admissions rose from 0.1% to 0.3%.

In addition, compared with surgeons who perform only 1 prostate biopsy per year, those who performed 25 or more biopsies per year had significant 35% decreased odds of post-biopsy infection and 50% decreased odds of hospitalization for post-biopsy infection.

“In the absence of an unforeseen confounding effect, our data suggest there is a component of surgeon volume contributing to infectious risks,” the authors wrote. “While the underlying reason for this association is unknown, technical skill, familiarity with prophylaxis protocols, office workflow, and post biopsy management are hypothetical contributing factors that deserve further exploration.”

Use of rectal swabs for targeted prophylaxis remains low (1.8% of biopsies in 2015), but did increase significantly from the 0.2% rate in 2001, according to the investigators.

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“Taken together, our findings on prostate biopsy patterns of care inform physicians, policy makers, and payers in terms of formulating incentives or policies to encourage the uptake of strategies to combat the increasing incidence of post-biopsy infectious complications,” Dr Hu’s team concluded.

In cautioning that their findings must be interpreted in the context of the study design, the authors pointed out that their use of Medicare data only allows them to access a proportion of prostate biopsy volume by surgeons. “However, it is very likely that biopsy volume in the elderly is strongly correlated to prostate volume irrespective of age,” they noted. In addition, the investigators said their use of Medicare claims data “may underestimate the true incidence of infectious complications that do not receive a diagnosis code, such as minor or self-limited prostatitis, cystitis and epididymitis.”

Reference

Shoag JE, Gaffney C, Pantuck M, et al. Risk factors for infection after prostate biopsy in the United States [published online December 30, 2019]. Urology. doi: 10.1016/j.urology.2019.12.023