Targeted Antimicrobial Prophylaxis Does Not Always Prevent Sepsis after Transrectal Prostate Biopsy

Area of Science:

• Urology
• Infectious Disease Prevention
• Antibiotic Prophylaxis

Background:

• Sepsis is a serious complication following transrectal prostate biopsy.
• Current prophylaxis strategies include targeted and empirical approaches.
• Optimizing antibiotic use is crucial to prevent post-biopsy infections.

Purpose of the Study:

• To compare the effectiveness of targeted prophylaxis versus augmented empirical prophylaxis and single-agent empirical prophylaxis in preventing sepsis after transrectal prostate biopsy.

Main Methods:

• Retrospective review of 15,236 transrectal prostate biopsy cases over 3 years.
• Analysis of sepsis incidence based on prophylaxis type: targeted, single-agent empirical, and augmented empirical.
• Multivariable analysis to assess the impact of prophylaxis strategy on sepsis rates.

Main Results:

• Augmented empirical prophylaxis demonstrated a significantly lower incidence of sepsis (OR 0.35) compared to single-agent empirical or targeted prophylaxis.
• No significant difference in sepsis rates was found between targeted and overall empirical prophylaxis.
• 38% of sepsis cases occurred despite patients receiving a seemingly appropriate prophylactic antibiotic.

Conclusions:

• Augmented empirical prophylaxis is statistically superior to single-agent empirical and targeted prophylaxis for preventing sepsis post-transrectal prostate biopsy.
• Sepsis can occur even when patients receive prophylactic antibiotics to which the causative bacteria are sensitive.
• Further research into antibiotic resistance patterns and prophylaxis optimization is warranted.