Infectious complications of transrectal prostate biopsy in patients receiving targeted antibiotic prophylaxis after urethral and rectal swab versus standard prophylaxis: A prospective comparative study

Sotirios Gatsos; Nikolaos Kalogeras; Georgios Dimakopoulos; Michael Samarinas; Anna Papakonstantinou; Efi Petinaki; Vassilios Tzortzis; Stavros Gravas

doi:10.1016/j.prnil.2023.11.002

Infectious complications of transrectal prostate biopsy in patients receiving targeted antibiotic prophylaxis after urethral and rectal swab versus standard prophylaxis: A prospective comparative study

Prostate Int. 2024 Mar;12(1):35-39. doi: 10.1016/j.prnil.2023.11.002. Epub 2023 Nov 23.

Authors

Sotirios Gatsos¹, Nikolaos Kalogeras², Georgios Dimakopoulos³, Michael Samarinas⁴, Anna Papakonstantinou², Efi Petinaki⁵, Vassilios Tzortzis¹, Stavros Gravas⁶

Affiliations

¹ Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
² Department of Urology, Agios Dimitrios General Hospital, Thessaloniki, Greece.
³ BIOSTATS, Epirus Science and Technology Park, Campus of the University of Ioannina, Ioannina, Greece.
⁴ Department of Urology, Koutlibanio General Hospital, Larisa, Greece.
⁵ Department of Microbiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
⁶ Medical School, University of Cyprus, Nicosia, Cyprus.

Abstract

Background: To evaluate the role of targeted antibiotic prophylaxis (TAP) after rectal and urethral swab cultures compared to empiric antibiotic prophylaxis (EAP) for the prevention of infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-Bx).

Methods: We conducted a prospective comparative study on 141 patients who underwent TRUS-Bx and were allocated in two groups. The first group (n = 71) received EAP with ciprofloxacin and the second (n = 70) received TAP according to rectal and urethral cultures. Post-biopsy infectious complications rates were compared between the two groups. Fluoroquinolone resistance (FQ-R) in the urethral and rectal swabs was recorded. Baseline characteristics were analyzed to assess their relationship with infectious complications and antibiotic resistance.

Results: A total of 8 infectious complications were observed, 7 of them in the EAP group (9.85%) and 1 in the TAP group (1.4%). There was a statistically significant difference in febrile UTIs between the two groups (6 vs 0, P = 0.028). FQ-R rate was 4.3% and 12.9% for rectal and urethral samples, respectively. Recent antibiotic exposure was associated with higher post-biopsy infection rates for EAP group and FQ-R rates for TAP group.

Conclusion: Combination of rectal and urethral swab cultures for TAP was able to detect FQ-R bacteria carriers and was associated with fewer infectious complications compared to EAP.

Keywords: Anti-bacterial agents; Biopsy; Prostate; Urinary tract infections.