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Infectious complications in patients undergoing transrectal prostate-biopsy with ciprofloxacin compared to

Andreas Banner1,2, Sebastian Ubber3, Ursula Stoces4

  • 1Department of Urology, Klinik Favoriten, Kundratstrasse 3, Vienna, A-1100, Austria. andreas.banner@gesundheitsverbund.at.

World Journal of Urology
|July 27, 2025
PubMed
Abstract

Insights

Fosfomycin-trometamol (FMT) prophylaxis for transrectal prostate biopsy (TrBx) carries a higher risk of infectious complications compared to ciprofloxacin (CIP). Clinicians should exercise caution with FMT and consider alternative antibiotics or biopsy methods.

Area of Science:

  • Urology
  • Infectious Diseases
  • Pharmacology

Background:

  • Transrectal prostate biopsy (TrBx) is a common procedure for diagnosing prostate cancer.
  • Antibiotic prophylaxis is crucial to minimize infectious complications following TrBx.
  • Ciprofloxacin (CIP) and fosfomycin-trometamol (FMT) are commonly used prophylactic agents.

Purpose of the Study:

  • To compare the risk of infectious complications between CIP and FMT prophylaxis in patients undergoing TrBx.
  • To evaluate the incidence of symptomatic urinary tract infections and hospitalizations post-TrBx.

Main Methods:

  • Retrospective, single-centre analysis of 913 patients undergoing TrBx from 2015-2023.
  • Patients received either CIP or FMT for antibiotic prophylaxis.
  • Primary endpoint: symptomatic UTIs within 30 days; Secondary endpoint: infectious complication hospitalizations. Logistic regression and chi-square tests were used for analysis.

Main Results:

  • Infectious complications occurred in 4.2% of all patients (2.4% with CIP vs. 6.2% with FMT).
  • FMT prophylaxis was associated with a significantly higher risk of infectious complications (aOR 2.99, p=0.008).
  • One death from sepsis occurred in the FMT group; hospitalization rates were similar between groups.

Conclusions:

  • FMT prophylaxis is linked to an increased risk of infectious complications after TrBx compared to CIP.
  • Cautious use of FMT is recommended; alternative antibiotic regimens or transperineal biopsy may be preferable.
  • Further research is needed to clarify FMT efficacy and optimize antibiotic stewardship for TrBx.
Keywords:
ComplicationInfectionPreventionProstate biopsyProstate cancer

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