[Prostate biopsy-infection prophylaxis and patient preparation]

Area of Science:

• Urology
• Infectious Diseases
• Medical Guidelines

Background:

• Prostate biopsy infection complications are a growing concern, exacerbated by restrictions on key prophylactic antibiotics.
• The European Association of Urology (EAU) guidelines address these challenges through meta-analyses of randomized controlled trials (RCTs).

Approach:

• The EAU Urological Infections Guideline Group conducted meta-analyses to evaluate prostate biopsy infection risks.
• Data from RCTs were analyzed to compare infectious complications between transrectal and transperineal biopsy routes.
• Current antibiotic prophylaxis strategies, including targeted, augmented, and empirical approaches, were reviewed.

Key Points:

• Transperineal prostate biopsy demonstrates significantly lower infectious complication rates than the transrectal route.
• Intrarectal cleansing with povidone-iodine is advised for transrectal biopsies.
• Antibiotic prophylaxis, including targeted, augmented, and empirical options, is crucial for transrectal procedures.

Conclusions:

• Transperineal prostate biopsy is the preferred method due to reduced infectious risks.
• When transrectal biopsy is necessary, specific protocols for cleansing and antibiotic prophylaxis must be followed.
• Evidence supports the use of aminoglycosides and third-generation cephalosporins in prophylaxis strategies.