Prophylactic Antibiotic Use in Transperineal Ultrasound-Guided Prostate Biopsy Under Local Anesthesia: A...

Transperineal prostate biopsy under local anesthesia (LATP) carries a low risk of infection, yet prophylactic antibiotics remain commonly used. This study evaluated infection outcomes with and without antibiotic use during LATP.  Methods: We conducted a retrospective analysis of 186 men undergoing LATP between February 2022 and June 2025 under the care of a single urologist. Patients either received a single prophylactic antibiotic dose (Group 1, n = 91) or no antibiotics (Group 2, n = 95). The primary outcome was urinary tract infection (UTI) within 30 days post-biopsy; secondary outcomes included hospital admissions for infection.

Baseline characteristics were similar between groups. The incidence of post-biopsy UTI was low and did not differ significantly between patients who received antibiotics and those who did not. No cases of sepsis occurred. Hospital admissions for infection-related complications were rare in both groups. A significant association was observed between smoking history and risk of UTI (p < 0.05), whereas other comorbidities showed no association.

In this cohort, the omission of prophylactic antibiotics during LATP prostate biopsy was not associated with an increased risk of infection. These findings support the safety of a no-antibiotic approach and highlight smoking as a potential risk factor for post-biopsy UTI. Broader adoption of selective antibiotic protocols may contribute to improved antimicrobial stewardship without compromising patient safety.