[Infectious complications following prostate biopsy-Major changes 2020]

Area of Science:

• Urology
• Infectious Diseases
• Antibiotic Prophylaxis

Background:

• Increasing rates of infectious complications following prostate biopsy.
• Suspension of fluoroquinolone prophylaxis in Germany due to safety concerns.
• Need for updated strategies to mitigate infection risks.

Purpose of the Study:

• To review current evidence-based strategies for reducing infectious complications after prostate biopsy.
• To provide guidance on antibiotic prophylaxis and procedural choices.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) by the European Association of Urology (EAU) guideline group.
• Focus on infectious complications related to prostate biopsy procedures.

Main Results:

• Transperineal prostate biopsy demonstrates significantly lower infectious complication rates compared to transrectal biopsy.
• For transrectal biopsies, intrarectal povidone-iodine cleaning and non-fluoroquinolone antibiotic prophylaxis are recommended.
• Alternative antibiotic prophylaxis strategies include targeted prophylaxis based on rectal flora susceptibility, augmented prophylaxis, and empiric monoprophylaxis with agents like aminoglycosides, third-generation cephalosporins, and fosfomycin trometamol.

Conclusions:

• The transperineal approach is the preferred method to minimize prostate biopsy-related infections.
• Fluoroquinolones are no longer recommended for prophylaxis.
• For transrectal biopsies, alternative antibiotics guided by local resistance data or targeted prophylaxis, combined with povidone-iodine preparation, are advised.