[Prostate biopsy-infection prophylaxis and patient preparation]
A Pilatz1, J Alidjanov2, G Bonkat3
1Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland. adrian.pilatz@chiru.med.uni-giessen.de.
Abstract:
Prostate biopsy has been at the center of controversy in recent years due to high infection complications associated with the transrectal route and the withdrawal of authorization for fluoroquinolones and fosfomycin trometemol as prophylaxis. The Urological Infections Guideline Group of the European Association of Urology (EAU) recently published a meta-analysis in two parts based on randomized controlled trials (RCTs) and annually updates the data for the EAU guidelines. The meta-analyses show that transperineal prostate biopsy is associated with significantly fewer infectious complications than transrectal biopsy and should therefore be preferred. If transrectal biopsy is still used, then intrarectal cleansing with povidone-iodine and antibiotic prophylaxis should be used. Antibiotic prophylaxis strategies include targeted prophylaxis after sensitivity testing of the rectal flora, augmented prophylaxis with several antibiotics and empirical monoprophylaxis. Data from RCTs are available for aminoglycosides and third-generation cephalosporins.
Insights
Transperineal prostate biopsy significantly reduces infection risks compared to transrectal biopsy. For transrectal procedures, intrarectal cleansing and appropriate antibiotic prophylaxis are recommended to minimize infectious complications.
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.
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