Comparison of Infectious Complications After Transrectal Prostate Biopsy Under Two Antibiotic Prophylaxis Regimens:...

To compare the effectiveness and safety of two antibiotic prophylaxis regimens, ciprofloxacin plus gentamicin and ceftriaxone plus cefixime, in preventing infectious complications after transrectal ultrasound-guided prostate biopsy.

The study retrospectively reviewed 705 consecutive patients who underwent transrectal ultrasound-guided prostate biopsy between January 2020 and January 2024. Group 1 (n = 374) received ciprofloxacin plus gentamicin, and Group 2 (n = 331) received ceftriaxone plus cefixime. All patients underwent standard rectal preparation with povidone-iodine, and needle-tip disinfection with formalin. The primary outcome was the development of post-biopsy infectious complications, while secondary outcomes included sepsis and infection-related hospitalization.

The two groups were comparable in terms of age, body mass index, prostate-specific antigen levels, and comorbidities. The overall rate of post-biopsy infection was 1.4%, occurring in 1.1% patients in Group 1 and 1.8% patients in Group 2 (p = 0.61). The incidence of complicated urinary tract infection was 0.3% versus 0.9%, and infection-related hospitalization occurred in 0.5% versus 0.3% of patients in Group 1 and Group 2, respectively, with no cases of sepsis observed. In univariable analyses, diabetes mellitus, histopathological chronic prostatitis, and pre-biopsy antibiotic use were not significantly associated with post-biopsy infection.

The combination of ceftriaxone and cefixime showed a safety profile broadly consistent with the combination of ciprofloxacin and gentamicin for biopsy prophylaxis. Considering increasing fluoroquinolone resistance and growing restrictions, this cephalosporin-based regimen may be considered a feasible option for transrectal ultrasound-guided prostate biopsy when implemented together with strict antiseptic measures.