Infectious complications following transperineal prostate biopsy with or without periprocedural antibiotic
Ingmar Wolff1, Markus Büchner2, Katharina Hauner3
1Department of Urology, University Medicine Greifswald, Greifswald, Germany. ingmar.wolff@med.uni-greifswald.de.
Background:
Despite the relatively low infection rate following transperineal prostate biopsy (TPB), it remains unresolved whether periprocedural antibiotic prophylaxis (PAP) can be omitted. Our aim was to compare infectious complications (genitourinary infections/GUI, fever, sepsis, readmission rate, 30-day-mortality) following TPB, considering all studies of varying levels of evidence that enable a direct comparison between patients with and without PAP.
Methods:
We performed a comprehensive search in PubMed/Medline, Embase, Web of Science, and Cochrane databases, as well as grey literature sources, to identify reports published until January 2024. All studies comparing the incidence of infectious endpoints following TPB with vs. without PAP were included in the analyses. The GRADE approach was employed to assess the certainty of evidence for each comparison.
Results:
Twenty-three studies met the inclusion criteria involving 6520 and 5804 patients who underwent TPB with vs. without PAP, respectively. Two of the 23 studies were randomized-controlled trials, not all studies investigated all endpoints. Pooled incidences between patients with vs. without PAP for the endpoints GUI (0.50% vs. 0.37%), fever (0.44% vs. 0.26%), sepsis (0.16% vs. 0.13%), and readmission rate (0.35% vs. 0.29%) showed no significant differences (all p > 0.250). The corresponding odds ratios (including 95% confidence interval) also revealed no statistically significant differences: 1.37 (0.74-2.54) [GUI], 0.87 (0.28-2.66) [fever], 1.30 (0.46-3.67) [sepsis], and 1.45 (0.70-3.03) [readmission rate]. No study reported events regarding 30-day-mortality. In subgroup analyses and sensitivity analyses, TPB without PAP showed no significantly higher complication rates regarding all analyzed endpoints.
Conclusions:
Infectious complications after TPB occur very rarely and cannot be further reduced by PAP. Considering the results of this systematic review and adhering to the principles of effective antibiotic stewardship, omitting PAP in the context of TPB is advisable.
Insights
Periprocedural antibiotic prophylaxis (PAP) is not necessary for transperineal prostate biopsy (TPB). This study found no significant difference in infectious complications between patients who received PAP and those who did not.
Area of Science:
- Urology
- Infectious Diseases
- Public Health
Background:
- Transperineal prostate biopsy (TPB) has a low infection rate, but the necessity of periprocedural antibiotic prophylaxis (PAP) is debated.
- Existing evidence on PAP's impact on infectious complications following TPB is varied.
Purpose of the Study:
- To compare infectious complications after TPB in patients with and without PAP.
- To evaluate the necessity of PAP for reducing genitourinary infections, fever, sepsis, and readmission rates.
Main Methods:
- A comprehensive systematic review and meta-analysis of studies published up to January 2024.
- Inclusion of randomized-controlled trials and other studies comparing TPB with vs. without PAP.
- Assessment of evidence certainty using the GRADE approach.
Main Results:
- Twenty-three studies involving over 12,000 patients were analyzed.
- No significant differences in pooled incidences of genitourinary infections (0.50% vs. 0.37%), fever (0.44% vs. 0.26%), sepsis (0.16% vs. 0.13%), or readmission rates (0.35% vs. 0.29%) were observed between groups.
- Subgroup and sensitivity analyses confirmed no significantly higher complication rates in patients not receiving PAP.
Conclusions:
- Infectious complications following TPB are rare and not significantly reduced by PAP.
- Omitting PAP for transperineal prostate biopsy is advisable, aligning with antibiotic stewardship principles.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:25Urinary Tract Infection II: Pathophysiology
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications