Infective Complications After Prostate Biopsy: Outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, A Prospective Multinational Multicentre Prostate Biopsy Study eulogo1

By: Florian M.E. Wagenlehnera lowast , Edgar van Oostrumb, Peter Tenkec, Zafer Tandogdud, Mete Çeke, Magnus Grabef, Björn Wulltg, Robert Pickardh, Kurt G. Naberi, Adrian Pilatza, Wolfgang Weidnera and Truls E. Bjerklund-Johansenj on behalf of the GPIU investigators.

Published online: 01 March 2013

Keywords: Prostate biopsy, Infective complications, Urinary tract infection, Antibiotic resistance

Abstract Full Text Full Text PDF (172 KB)



Infection is a serious adverse effect of prostate biopsy (P-Bx), and recent reports suggest an increasing incidence.


The aim of this multinational multicentre study was to evaluate prospectively the incidence of infective complications after P-Bx and identify risk factors.

Design, setting, and participants

The study was performed as an adjunct to the Global Prevalence Study of Infections in Urology (GPIU) during 2010 and 2011. Men undergoing P-Bx in participating centres during the 2-wk period commencing on the GPIU study census day were eligible.

Outcome measurements and statistical analysis

Baseline data were collected and men were questioned regarding infective complications at 2 wk following their biopsy. The Fisher exact test, Student t test, Mann-Whitney U test, and multivariate regression analysis were used for data analysis.

Results and limitations

A total of 702 men from 84 GPIU participating centres worldwide were included. Antibiotic prophylaxis was administered prior to biopsy in 98.2% of men predominantly using a fluoroquinolone (92.5%). Outcome data were available for 521 men (74%). Symptomatic urinary tract infection (UTI) was seen in 27 men (5.2%), which was febrile in 18 (3.5%) and required hospitalisation in 16 (3.1%). Multivariate analysis did not identify any patient subgroups at a significantly higher risk of infection after P-Bx. Causative organisms were isolated in 10 cases (37%) with 6 resistant to fluoroquinolones. The small sample size per participating site and in compared with other studies may have limited the conclusions from our study.


Infective complications after transrectal P-Bx are important because of the associated patient morbidity. Despite antibiotic prophylaxis, 5% of men will experience an infective complication, but none of the possible factors we examined appeared to increase this risk. Our study confirms a high incidence of fluoroquinolone resistance in causative bacteria.

Take Home Message

This study prospectively confirmed that infective complications after prostate biopsy have become an important health problem that causes significant morbidity and hospitalizations annually worldwide. The major risk factor for infective complications after prostate biopsy was the fluoroquinolone resistance of causative bacteria.

Keywords: Prostate biopsy, Infective complications, Urinary tract infection, Antibiotic resistance.


a Department of Urology, Paediatric Urology and Andrology of the Justus-Liebig-University, Giessen, Germany

b EAU Department, Arnhem, The Netherlands

c Department of Urology, Jahn Ferenc South-Pest Hospital, Budapest, Hungary

d Department of Urology, Taksim Teaching Hospital, Istanbul, Turkey

e Department of Urology, Trakya University, Edirne, Turkey

f Department of Urology, Skåne University Hospital, Malmö, Sweden

g Department of Microbiology, Immunology and Glycobiology, Lund, Sweden

h Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK

i Technical University, Munich, Germany

j Department of Urology, Aarhus University Hospital, Denmark

lowast Corresponding author. Department of Urology, Paediatric Urology and Andrology, Justus-Liebig-University, Giessen, Rudolf-Buchheim-Str. 7, 35385 Giessen, Germany. Tel. +49 641 98544516; Fax: +49 641 98544509. Please visit to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.