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MP11-20: The difficulty interpreting endotoxaemia post transrectal prostate biopsy

Friday, May 12
1:00 PM - 3:00 PM
Location: BCEC: Room 151

Presentation Authors: Peter Thompson*, Wei Wang, Hemant Nemade, Srinath Chandersekara, Sharon Sheehan, Elias Khalifa, John Philpott - Howard, London,, United Kingdom, Elias Khalifa, London, United Kingdom

Introduction: A prospective study to measure sepsis and endotoxaemia following prostate biopsy

Methods: 67 consecutive patients received ciprofloxacin and metronidazole prophylaxis. Blood cultures and endotoxin assay were performed at 5 and 60 min and 24 hours post biopsy. Prostate needle washings were cultured.

Results: 61/67 patients (91.0%) had positive cultures from needle washings. 6/67 patients (9.0%) had positive blood cultures. Endotoxin assay was performed on 66 samples at 5 min, 60 samples at 60 min, and 55 samples 24 h post biopsy. Endotoxin was detected in 62/66 (94.0%) at 5 minutes, 53/60 (88.3%) at 60 minutes and 55/60 (91.6%) at 24 hours.

Conclusions: This study demonstrates the translocation of gut endotoxin post TRPB. The non portal venous drainage of the prostate is an explanation for the endotoxins measured after biopsy. These findings of endotoxaemia are in keeping with the landmark studies previously performed that demonstrated endotoxin in the unprotected placebo group.

The Prostate, Lung, Colorectal and Ovary (PLCO) study reported a mortality rate at 120 days post TRPB of 1.3 deaths per 1,000 biopsies in the negative biopsy group. This compares with the risk reported by Gallina et al in a population-based study, with overall 120-day mortality after biopsy of 1.3% versus 0.3% in the control group.
A review of cardiac complications after pneumonia showed a significant increase in cardiac mortality. The effect of circulating inflammatory mediators such as endotoxins leading to non-ischaemic myocardial injury is proposed as one of the potential mechanisms contributing to myocardial dysfunction.

This study raises several issues. What is the significance of endotoxin detection in the serum samples after prostate biopsy? Is this related to the increased mortality in relation to cardiovascular dysfunction of this group?
The WHO's Global Action Plan on Antimicrobial Resistance in 2015 emphasises that we have a duty of governance and stewardship to review the implementation of alternative surgical approaches that will allow limitation of antibiotic prophylaxis in TRPB.
While we endeavour to understand the clinical significance of the association between bacteraemia and endotoxaemia after transrectal prostate biopsy it is important that we share with the patients the worldwide risks of the procedure as we strive to make prostate biopsy safer.

Source Of Funding: The study protocol was approved by the NHS Integrated Research Ethics System(London UK) 10/H0722/39 and the Hospital KCH10-069

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