Factors associated with urinary tract infections in patients undergoing transrectal prostate biopsy at adult hospital of the university teaching hospitals, Lusaka, Zambia.

Background: Transrectal prostate biopsy is currently the standard technique for
obtaining tissue to make a histological diagnosis of prostate cancer. Infectious
complications after the procedure can occur despite patients being on antibiotic
prophylaxis. These complications range from being mild to severe and life-threatening.
Growing evidence attributes this to the increasing resistance to the commonly used
antimicrobial agents. The study therefore aimed at evaluating the risk factors of urinary
tract infections following prostate biopsy, establishing the pathogens involved and their
resistance patterns.
Methodology: This was a prospective cross-sectional study of a consecutive cohort of
patients who underwent transrectal prostate biopsy at the adult Hospital of the
University Teaching Hospitals between September 2019 and February 2020. All patients
meeting the inclusion criteria were enrolled, demographic and clinical details were
obtained using a questionnaire. Rectal swabs and urine for culture were collected before
the procedure. A second urine sample for culture was collected one week after the
procedure. Data analysis was conducted using STATA version 13 and results with pvalue
less than 0.05 were considered significant.
Results: Of the 139 patients who participated in the study, 18 (12.9%) had a urinary
tract infection after prostate biopsy. HIV seropositive status was a significant predictor
for development of UTI after prostate biopsy. Escherichia coli was the most common
pathogen isolated in the rectal swab (63%). In post biopsy urine, Escherichia coli was
isolated in 67% (12/18) of patients with UTI. Its resistance to the routinely used
antibiotic (Ciprofloxacin) was 83% (10/12) and sensitivity to Fosfomycin and
Nitrofurantoin was 100 % and 75% respectively.
Conclusion: The prevalence of UTIs after transrectal prostate biopsy was 12.9% and E
coli was the main causative organism. HIV seropositive status, history of having been in
acute urinary retention and paraplegia were independent predictors of UTI after prostate
biopsy.
Keywords: pre-biopsy antibiotic prophylaxis, transrectal prostate biopsy, rectal swab,
urinary tract infection.