Antibiotic resistance across Europe and in other regions as well has increased in recent years and the key to combat resistance can only be possible if doctors get their act together to reduce antibiotic use and avoid unnecessary procedures that contribute to patient vulnerability.
“The resistance to E.coli is booming. Resistance all over Europe is increasing and the only way to stop this is to follow the Guidelines and decrease antibiotic consumption,” said F. Bruyere (FR) who gave an update on EAU Guidelines, particularly on urinary tract infections.
“Urologists are among the biggest users and misusers of antibiotics,” added Bruyere in his concluding remarks as he emphasized that sticking to the Guidelines is the safest way to “…avoid the disaster of antibiotic resistance.”
He also noted there is strong evidence for peri-operative such as withholding antibiotic use for cystoscopy or obtaining sterile urine before urological surgery. He also urged urologists not to extend the number of days in antibiotic use. “For example one day of antibiotic use is enough in some cases,” he said.
T.E. Bjerklund Johansen (NO), meanwhile, gave a comprehensive overview on the management of complications after prostate biopsies. “A 30-day mortality rate of 0.1% to 0.2% has been reported after prostate biopsies. A rate of 0.2% translates to 4,000 men dying from prostate biopsies in the US and Europe every year,” Johansen said.
Johansen also stressed that prostate biopsies should be justified. “Biopsies should not be performed unless histological findings will be of benefit to the patient,” he said and added that several scenarios should first be considered such as the role of biopsies in radical treatment and focal therapy.
Regarding the issue of reducing the contamination status of a patient, Johansen explained that transperineal biopsies have the lowest contamination category. He also recommended prophylaxis routines such as rectal cleansing, with one study noting the benefit of using bisacodyl. Hygienic measures also included needle use, disinfection of the biopsy channel and proper training for the urologist and assistants, among others.
In his take-home messages, Johansen said: “The benefit of diagnosing prostate cancer must be balanced against side effects before a biopsy is performed. The increasing antibiotic resistance makes prophylaxis and treatment difficult and adds to the severity of the situation.”
According to Johansen, future research should be directed at reducing the need for prostate biopsies and the contamination status of the biopsy procedure.