Preprostate Biopsy Rectal Culture and Postbiopsy Sepsis

Transrectal ultrasound-guided biopsy of the prostate (TRUSP) remains the primary procedure for the accurate histologic diagnosis of prostate cancer. Fluoroquinolones (FQs) are still recommended as the agents of choice for antimicrobial prophylaxis for TRUSP despite the alarming increasing incidence of FQ-resistant organisms among men undergoing TRUSP. This article reviews the current TRUSP antimicrobial prophylaxis guidelines, antimicrobial resistance and its implications for these guidelines, the incidence of post-TRUSP infectious complications including urosepsis, the seminal data supporting pre-TRUSP rectal swab (RS), RS technique and protocol, and the current available literature surrounding the efficacy of RS in reducing post-TRUSP infectious complications.