Use versus nonuse of antimicrobial prophylaxis prior to transperineal prostate biopsy: a propensity score-matched
Dong Sup Lee1, Seung-Ju Lee1, Su Jin Kim1
1Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Background:
Transperineal prostate biopsy offers advantage over a transrectal approach by reducing the risk of infectious complications. However, the necessity for antimicrobial prophylaxis (AP) before a transperineal prostate biopsy is less clear. This study aimed to study the rate of infectious complications following transperineal prostate biopsy with or without AP.
Materials And Methods:
Propensity score matching was done for 1,273 patients who underwent transperineal prostate biopsy between October 2020 and October 2024 to adjust for differences in covariates. Parameters including the rate of urinary tract infection (UTI) requiring or not requiring hospitalization between patients who received AP and those who did not receive AP were then compared.
Results:
A total of 288 patients were matched for each group and baseline characteristics were balanced between groups. The overall incidence of UTI was very low in both groups without significant difference. UTI requiring hospitalization occurred in only one patient in the AP group (0.1%) and none in the non-AP group. Nonhospitalized UTI occurred in 0.7% of the AP group and 0.3% of the non-AP group (P = 1.000).
Conclusion:
There was no significant difference in the rate of UTI based on the use or nonuse of AP prior to transperineal prostate biopsy. The overall incidence of UTI was very low regardless of the use of AP. Omission of AP prior to transperineal prostate biopsy might be possible, which would help promote antimicrobial stewardship.
Insights
Antimicrobial prophylaxis (AP) is not necessary before transperineal prostate biopsy, as infectious complications like urinary tract infections (UTIs) are rare and similar with or without AP. This finding supports antimicrobial stewardship efforts.
Area of Science:
- Urology
- Infectious Diseases
- Surgical Oncology
Background:
- Transperineal prostate biopsy is preferred over transrectal biopsy due to lower infectious complication rates.
- The need for antimicrobial prophylaxis (AP) before transperineal prostate biopsy remains unclear.
Purpose of the Study:
- To evaluate the incidence of infectious complications after transperineal prostate biopsy.
- To compare infection rates with and without the use of AP.
Main Methods:
- Propensity score matching was used for 1,273 patients undergoing transperineal prostate biopsy.
- Compared rates of urinary tract infection (UTI), including hospitalized and non-hospitalized cases, between patients who received AP and those who did not.
Main Results:
- 288 patients were matched per group with balanced baseline characteristics.
- Overall UTI incidence was low and not significantly different between groups.
- Hospitalized UTI occurred in 0.1% of the AP group vs. 0% in the non-AP group; non-hospitalized UTI occurred in 0.7% vs. 0.3% (P=1.000).
Conclusions:
- No significant difference in UTI rates was observed based on AP use before transperineal prostate biopsy.
- The overall incidence of UTI is very low, irrespective of AP.
- Omitting AP may be a viable strategy to promote antimicrobial stewardship.
