Post-biopsy infection and sepsis rates are significantly higher in groups of patients given empirical fluoroquinolone prophylaxis when compared to those who receive antimicrobial therapy. These are the results of a review paper titled “The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography-guided prostate biopsy in reducing infection rates: a systematic review,” published in BJU International, that evaluated the current recommendations for antimicrobial prophylaxis (prevention of disease) to reduce the risk of post-TRUS biopsy infective complications (PTBICs).

Transrectal ultrasonography (TRUS)-guided biopsy is currently the standard method used to obtain tissue samples for histological diagnosis of prostate cancer. However, the biopsy technique is associated with several health risks, such as pain, urinary retention, and, most importantly, infection, which can range from UTI (urinary tract infection) to severe sepsis.

Such post-TRUS biopsy infective complications (PTBICs) are an important and costly issue. Routine prevention of infections relies on the use of fluoroquinolone antibiotics, which tend to reach high concentrations in the prostate after oral administration. However, PTBICs are increasingly linked with fluoroquinolone resistant (FQ-R) E. coli, a pathogen that is present in 75 to 90 percent of PTBICs cases. In light of these facts, researchers theorized that the recommendations for infection prevention that are currently implemented might need to be reviewed. One such approach is pre-biopsy screening for FQ-R, which allows the physician to tailor the antimicrobial prophylaxis to each individual patient. However, there is still not enough data that cements the recommendation of pre-biopsy screening programs.

Researchers combed through a series of studies found in numerous databases to compare the incidence of PTBICs after prophylaxis with empirical fluoroquinolone and culture-based targeted antibiotics, tailored to the individual patient. Nine studies — six from North America and the others from Turkey, Spain, and Columbia — met the inclusion criteria and included data from 4,571 patients. Among these patients, 54.3 percent received empirical fluoroquinolone prophylaxis and 45.7 percent had pre-biopsy rectal swabs and targeted antibiotics. The mean prevalence of FQ-R, recorded as a secondary outcome, was of 22.8 percent.

Researchers found that post-biopsy infection and sepsis rates were significantly higher in groups of patients who were given the empirical fluoroquinolone prophylaxis compared with groups who received targeted antibiotics:  4.55 percent and 2.21 percent compared to 0.72 percent and 0.48 percent. Moreover, 27 men would need to receive targeted antibiotics to prevent one infective complication.

Senior author Dr. Tim Dudderidge, consultant urological surgeon at Southampton General Hospital, said in a press release, “In light of these findings we are planning to introduce rectal swabs and targeted antibiotic prophylaxis as a necessary preparation for transrectal prostate biopsy. The only question is whether techniques involving multiparametric MRI of the prostate and targeted transperineal biopsy will make transrectal biopsy obsolete first.”