Oral antibiotics in trans-rectal prostate biopsy and its efficacy to reduce infectious complications: Systematic review

Abstract

For the diagnosis of prostate cancer trans-rectal prostate biopsy (TRPB) is used commonly, the procedure is associated with infective complications. There is evidence that antibiotics (ABx) decrease infective events after TRPB, but different regimens are used. To systematically review different regimens of prophylactic oral ABx in TRPB. MEDLINE, EMBASE, clinical trials site, and Cochrane library were searched, experts were consulted for relevant studies. Randomized clinical trials conducted in the last 20 years, which investigated the different oral antibiotic regimens in TRPB, and compared their efficacy to reduce infectious complications were analyzed. Primary outcomes were bacteriuria, urinary tract infection (UTI), fever, bacteremia, and sepsis. Secondary outcomes were the hospitalization rate and the prevalence of ABx-resistant bacteria. Nine trials were eligible with 3012 patients. ABx prevented bacteriuria (3.5% vs. 9.88%), UTI (4.46% vs. 9.75%), and hospitalization (0.21% vs. 2.13%) significantly in comparison with placebo or no treatment. No significant difference was found in all the outcomes of the review between the single dose regimen and the 3 days. The single dose regimen was as effective as the multiple doses except in bacteriuria (6.75% vs. 3.25%), and the prevalence of ABx-resistant bacteria (1.57% vs. 0.27%). Quinolones reduced only UTI significantly in comparison with other ABx (chloramphenicol, trimethoprim-sulfamethoxazol). It is essential to prescribe prophylactic ABx in TRPB. No conclusive evidence could be claimed about the superiority of the multiple or the 3 days regimens to the single dose regimen. Unexpectedly, ABx-resistant bacteria were identified more often in the single dose cohorts.

Topical antiseptic at time of transrectal ultrasound prostate biopsy is associated with fewer severe clinical infections and improves antibiotic stewardship

“…Specifically, data do highlight variances in local antibiogram based on local region. 16 Second, the potential exists to miss subclinical infections or those that may have been managed outside of our health system. Third, this experience does not reflect incorporation of a rectal swab protocol which can culture for quinolone resistant gram-negative organisms.…”

Cefixime versus prulifloxacin as a prophylactic treatment for prostate biopsy: a randomized study

“…As men undergoing TRUS-guided prostate biopsy have a 2.26-fold risk for hospitalization [ 2 ], the need for developing novel approaches to prevent biopsy-related UTIs becomes mandatory. Until now, several alternative prophylactic regimens have been tested, including fluoroquinolones and other treatments, in order to avoid urinary tract infections and sepsis after prostate biopsy [ 19 , 29 ].…”