Comparison of Single and Prolonged Fluoroquinolone Prophylaxis and Risk Factors for Infectious Complications After Transrectal Prostate Biopsy

Abstract

Background: The ideal prophylaxis duration for transrectalultrasonography-guided prostate biopsy is incompletely defined.Aims: To compare the infectious complications of transrectalultrasonography-guided prostate biopsy with and without extendedantibiotic prophylaxis. The secondary aim was to evaluate the riskfactors for infectious complications.Study Design: Prospective observational study.Methods: Four hundred patients who underwent transrectalultrasonography-guided prostate biopsy were recruited. Patientsorally received either 750 mg ciprofloxacin 60 min before theprocedure or 500 mg ciprofloxacin twice a day for a duration of 7days with the initial dose administered 24 h prior to the procedure.All patients were followed-up for 4 weeks after the transrectalultrasonography-guided prostate biopsy procedure for infectiouscomplications. Screening of urine was carried out in all patients onthe 3rd and 7th day after the procedure. Medical histories of all patientswere collected prior to biopsy. Information on medical history includethe following: hospitalization, urethral catheterization, or urinary tractinfections within the past 12 months; antibiotic use within the last3 months, prior urinary tract interventions, and previous transrectalultrasonography-guided prostate biopsy and Charlson comorbidityindexes. Ultrasound-guided biopsy was carried out using GeneralElectric’s 7 MHz transrectal ultrasound device in the left decubitusposition. Patients received one of the two ciprofloxacin-basedprophylaxis regimens. Subsequent transrectal ultrasonographyguidedprostate biopsy to all patients were followed-up for 30 days.Further follow-up of patients was carried out on the second and fourthweeks after transrectal ultrasonography-guided prostate biopsy, andsymptoms, such as dysuria, rectal bleeding, fever, hematospermia,hematuria, and pollakiuria, were recorded.Results: Both groups presented similar baseline characteristics andmedical history. Infectious complication rates within the 4-weekfollow-up were similar in both groups (single dose: 3% vs prolonged:3%) (p>0.05). In both groups, infectious complications significantlyincreased than that at previous antibiotic usage (single: p=0.028;prolonged: p=0.040). Non-infectious complication ratios showed nosignificant variation (p>0.05).Conclusion: Pre-operative single dose of 750 mg oral ciprofloxacincompared with 7 days prolonged treatment resulted in similarinfectious complication outcomes in patients undergoing transrectalultrasonography-guided prostate biopsy. The use of antibioticswithin the last 3 months increases the risk for post-transrectalultrasonography-guided prostate biopsy infectious complications.