Introduction Infections of the urinary tract (UTIs) pose a serious health problem for patients at high cost for society. UTIs are also the most frequent healthcare associated infections. E. coli is the predominating pathogen in uncomplicated UTIs while other Enterobacteriaceae and Enterococcus spp are isolated in higher frequency in patients with urological diseases. The present state of microbial resistance development is alarming and the rates of resistance are related to the amount of antibiotics used in the different countries. Particularly worrisome is the increasing resistance to broad spectrum antibiotics. It is thus essential to limit the use of antibiotics in general and fluoroquinolones and cephalosporins in particular, especially in uncomplicated infections and asymptomatic bacteriuria.

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Guidelines on Urological Infections

Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective european prostate cancer detection study

Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature

Summary— Transrectal ultrasound (TRUS) is becoming more widely used as a method of investigating prostatic disease. This study investigated the acceptance of this technique in 89 patients undergoing evaluation for suspected malignant disease. The true morbidity associated with TRUS and TRUS-guided biopsy was evaluated. Serious complications were rare, but minor complications were frequent. Careful counselling is recommended prior to the procedure in order to minimise the patients' anxiety and ensure that if complications do occur they are dealt with swiftly and appropriately.

Multiple transrectal ultrasound-guided prostatic biopsies--true morbidity and patient acceptance.

Objectives To determine the effect of antibiotic prophylaxis on infective complications after transrectal needle biopsy of the prostate



Patients and methods Between June 1996 and September 1998, 231 patients who satisfied the inclusion and exclusion criteria entered the study; the patients were randomized into three groups Each patient underwent transrectal needle biopsy of the prostate after a cleansing enema at 06:00 hours Patients in group 1 (75) then received a placebo tablet twice a day for 3 days; those in group 2 (79) were given a single dose of ciprofloxacin (500 mg) and tinidazole (600 mg), while those in group 3 (77) were given the same combination twice a day for 3 days Urine cultures were obtained 48 h after the biopsy and blood cultures only from patients who developed fever The complications (categorized as infective or noninfective) occurring in the three groups were compared using the chi-square test



Results Noninfective complications included were lower urinary tract symptoms, rectal bleeding, haematuria and perineal pain The infective complications included urinary tract infection and fever There was no significant difference among the three groups in noninfective complications (27, 29 and 31 in groups 1–3, respectively) but the incidence of infective complications (19, six and eight, respectively) was significantly higher in group 1 (P = 0003) However, the difference was significant only for urinary tract infection (P = 001) and not for fever



Conclusions In selected patients a single dose of ciprofloxacin-tinidazole is adequate prophylaxis for transrectal needle biopsy of the prostate The present urinary infection rate was higher if no antibiotics were used Continuing the antibiotic prophylaxis for 3 days offered no benefit over single-dose prophylaxis

Mark W. Story

Papers

Prevention of urinary tract infection and sepsis following transrectal prostatic biopsy.