Re: Marco Borghesi, Hashim Ahmed, Robert Nam, et al. Complications after systematic, random, and image-guided prostate biopsy.

Abstract

In a recent review, Borghesi et al concluded that sepsis is the most troublesome complication following transrectal prostate biopsy and that its incidence continues to increase due to the ongoing rise of fluoroquinolone resistance. We believe the time is nigh to abandon the transrectal approach. In performing transrectal biopsy, we forsake basic surgical principles of sterility for the convenience of this approach, using antibiotics as a substitute for hygiene. Quinolones are recommended as standard prophylaxis, but are losing their effect. The US Center for Disease Control states that “use of antibiotics is the single most important factor leading to resistance around the world”. The World Health Organization implores us to reduce unnecessary antibiotic usage for fear of creating a postantibiotic era. Proposed preventative solutions to prostate biopsy sepsis involving multidrug or broader spectrum prophylaxis are therefore in direct contravention of these warnings and are irresponsible. Continues.