Trans-perineal prostate biopsy safe even without antibiotic prophylaxis

Antibiotic prophylaxis (AP) does not impact the incidence of urinary tract infections (UTI) after trans-perineal prostate biopsy (TP-PB), a new study has found.

Researchers conducted a prospective, double-centre trial including 200 TP-PB patients, half of whom received the standard AP (controls) while the other half were not given AP. The primary outcome was the incidence of UTI or bacteriuria 2 weeks after the procedure, and as measured using a urine culture.

Baseline characteristics were comparable between groups, except for mean prostate volume (mean, 65.5 vs 51 mL; p<0.001) and number of biopsy cores (mean, 17.8 vs 14.9; p<0.001), both of which were higher in the no-AP group. The prostate cancer detection rate was similar between groups (p=0.569).

One patient in the no-AP arm developed post-PB UTI, which was found by urine culture to be of Escherichia coli. This patient presented with fever and dysuria 6 hours after surgery. Management was done with oral antibiotics and anti-inflammatory drugs and was accomplished in the outpatient department. UTI resolved after 5 days. No post-PB UTI cases were reported in the AP arm.

The 14-day urine culture analysis found three patients with asymptomatic bacteriuria in the no-AP group, as opposed with five in the AP arm. The between-group difference was not significant (p=0.470). Asymptomatic episodes were not treated with antibiotics. Other post-PB complications likewise occurred at comparable rates between groups.

“We demonstrated that TP-PB without AP was safe. AP did not have a relevant impact on post-procedure UTI and related complications. Wider use of TP-PB without AP would critically reduce the unnecessary administration of antibiotics worldwide,” the researchers said.