Prophylactic Antibiotics in Prostate Biopsy: A Meta-Analysis Based on Randomized Controlled Trials

Area of Science:

• Urology
• Infectious Diseases
• Pharmacology

Background:

• Transrectal prostate biopsy (TRPB) frequently uses prophylactic antibiotics.
• Increasing rates of urinary tract infection (UTI) and antibiotic resistance necessitate evaluating current prophylaxis regimens.
• This study aims to assess the efficacy of antimicrobial prophylaxis in TRPB.

Purpose of the Study:

• To evaluate the effectiveness of current antimicrobial prophylaxis regimens for transrectal prostate biopsy (TRPB).
• To identify optimal antibiotic strategies for reducing infectious complications post-TRPB.

Main Methods:

• Systematic search of PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs).
• Included 22 RCTs with 3846 patients comparing antibiotic prophylaxis versus placebo/no treatment.
• Outcomes assessed included bacteriuria, bacteremia, drug-resistant bacteria, fever, UTI, sepsis, and hospitalization.

Main Results:

• Antibiotic use significantly favored reduced bacteriuria, bacteremia, fever, UTI, and hospitalization compared to placebo/no treatment (p<0.05).
• Short-course and single-dose treatments showed a higher risk of bacteriuria compared to longer/multiple doses (p=0.01).
• No significant differences were observed between oral vs. systemic administration or among different antibiotic classes.

Conclusions:

• Prophylactic antibiotics are beneficial in reducing infective complications following TRPB.
• Optimal strategy involves single-dose or short-course oral antibiotics of any type.
• Adding a second antibiotic may help minimize severe infections and combat drug resistance.