What is the Infectious Risk of Prostate Biopsy: The Global Prevalence of Infections in Urology (GPIU) Study

Background: Reports suggest an increase of life-threatening infectious complications following prostate biopsies (P-Bx).  Methods: Risk factors and time trends in rates of infectious complications were evaluated in the multicentre, worldwide, prospective Global Prevalence of Infections in Urology (GPIU) study 2010-2018. The primary outcome was infectious complications after P-Bx. Uni- and multivariate statistical analysis, two-sample t and chi-square tests were used. Findings: Outcome data were available for 1556 men. Rates of symptomatic complications increased from 6.1% in 2010 to 10.2% in 2018. Prevalence of symptoms of urinary tract infections (UTI) justifying antibiotic treatment was 6.5%. Fluoroquinolone-based prophylaxis was administered in 79.7%. Transperineal P-Bx, repeated P-Bx, aminoglycosides as prophylaxis and histopathologic signs of inflammation in the prostate were risk factors to develop symptoms of UTI. Inflammation of the prostatic tissue was associated with a higher number of post-P-Bx symptoms. Of 88 urine cultures post-P-Bx, 33 were positive (37.5%). Escherichia coli was the most common causative uropathogen (75.8%). Resistance rate to fluoroquinolones was 60.0%. Following transrectal P-Bx, 3.9% of patients required hospitalization and 2.7% developed febrile infections. Two men (0.13%) died after transrectal P-Bx due to sepsis. Interpretation: Symptoms of UTI after P-Bx increased during study period. Inflammation of the prostatic tissue is associated with a higher number of post-P-Bx symptoms. Transrectal P-Bx was a risk factor for severe complications, such as febrile UTIs and mortality. Funding: European Section of Infections in Urology (ESIU), European Association of Urology (EAU), EAU Research Foundation (EAU RF), Technische Hochschule Mittelhessen (THM), Germany, Merian Iselin Foundation, Switzerland. Declaration of Interests: Authors have no potential conflict of personal interest to disclose that could give the appearance of potentially influencing the submitted work. Ethics Approval Statement: The GPIU study was approved by the Ethical Committee of the Justus Liebig University, Giessen, Germany (ethical vote: AZ:116/07). Due to the multicentric and multinational nature, obtaining regulatory approval was the responsibility of each study centre.