No benefit to targeted antibiotic prophylaxis before TRUS-guided prostate biopsy
Targeted antibiotic prophylaxis – after a rectal swab to identify specific intestinal flora – does not appear to significantly impact the risk of urinary sepsis following a transrectal ultrasound (TRUS)-guided prostate biopsy, according to a recent study.
Researchers assessed data of 308 patients who had undergone TRUS-guided prostate biopsy with a standard 3-day antibiotic prophylaxis course of oral ciprofloxacin between January and September 2016 at a single centre in England. They compared the incidence of urinary infection or suspected post-TRUS sepsis within 7 days in this group with that of 315 patients who underwent TRUS-guided prostate biopsy between January and September 2017 who had targeted antibiotic prophylaxis following a pre-biopsy rectal swab to identify resistant bacteria in the intestinal flora.
The rate of hospital admission for urinary sepsis following the TRUS-guided biopsy was comparable between patients who underwent standard and targeted antibiotic prophylaxis (2.6 percent vs 1.6 percent; p=0.4). [EAU 2018, abstract 966]
Twenty-one patients in the targeted antibiotic prophylaxis group had ciprofloxacin-resistant organisms on the rectal swabs, with extended-spectrum beta-lactamases and ciprofloxacin-resistant Escherichia coli detected in five and 16 patients, respectively.
None of the 18 patients who underwent TRUS-guided prostate biopsy after targeted antibiotic prophylaxis developed sepsis.
“We found a statistically insignificant absolute risk reduction of 1 percent with post-TRUS infection rates falling from 2.6 to 1.6 percent [with the use of a rectal swab to enable targeted antibiotic prophylaxis],” said the researchers.
According to the researchers, the incidence of infection after TRUS-guided biopsy is on the rise, placing a significant impact on healthcare resources. Furthermore, the incidence of antibiotic resistance is also increasing worldwide.
“Efforts to reduce the occurrence of sepsis continue, but this study has demonstrated that although a small reduction in post-TRUS biopsy sepsis was observed following the introduction of the rectal swab and targeted antibiotics, it was not statistically significant,” they said.
Given the “limited benefit”, the researchers also pointed to the lack of cost-effectiveness of the rectal swab, as each swab costs an estimated £3–4, and this has yet to take into consideration the price of the targeted antibiotic.
“TRUS-guided biopsy of the prostate remains the mainstay of prostate cancer diagnosis,” said Jennifer Martin from the Royal Cornwall Hospital in Truro, Cornwall, England, who presented the findings.
“Transperineal prostate biopsy may soon replace the traditional TRUS biopsy, negating the need for antibiotic prophylaxis at all, but this remains someway in the future,” said Martin and co-researchers.