Targeted Prophylaxis Before Prostate Biopsy Cuts Sepsis Risk

Men undergoing transrectal ultrasound (TRUS)-guided prostate biopsy may experience lower rates of sepsis with targeted antimicrobial prophylaxis instead of standard empirical fluoroquinolone, a new British review suggests.

Investigators led by Timothy J. Dudderidge, MB ChB MSc FRCS, consultant urological surgeon at University Hospital Southampton in the UK, compared rates of infective complications, such as urinary tract infection and sepsis, after TRUS-guided biopsy. In pooled results from 9 studies (a mix of retrospective and prospective data), 2,484 patients received empirical fluoroquinolone and 2,087 targeted antibiotics based on results of pre-biopsy rectal swab cultures.

Infection and sepsis rates were significantly higher among patients receiving empirical prophylaxis (4.55% and 2.21%) compared with patients receiving targeted antibiotics (0.72% and 0.48%), according to results published in BJU International. Fluoroquinolone resistance was found in 22.8% of men with culture results.

Based on these results, 27 men would need to receive targeted antibiotics to prevent 1 infective complication. The cost-benefit ratio likely would be favorable if it prevented a hospital admission for sepsis.

"In light of these findings we are planning to introduce rectal swabs and targeted antibiotic prophylaxis as a necessary preparation for transrectal prostate biopsy," Dr. Dudderidge stated in a press release. Optimal timing and collection of rectal swab still need to be determined. 

Alternatives to targeted antimicrobial therapy such as pre-biopsy rectal cleansing and disinfection and low-resistance, broad-spectrum antibiotics need further study. “The only question is whether techniques involving multiparametric MRI of the prostate and targeted transperineal biopsy will make transrectal biopsy obsolete first,” according to Dudderidge.
Limitations of the review included possible selection bias from non-randomized studies and lack of standardized methodology for rectal cultures.

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