MP09-01: The Role of Prophylactic Antibiotics in Transperineal Prostate Biopsy: A Systematic Review and Metanalysis

Spyridon Basourakos, New York, NY, Mark Alshak, Baltimore, MD, Patrick Lewicki, Emily Cheng*, Michael Tzeng, Antonio DeRosa, New York, NY, Matthew Allaway, Cumberland, MD, Ashley Ross, Edward Schaeffer, Hiten Patel, Chicago, IL, Jim Hu, New York, NY, Michael Gorin, Cumberland, MD

Introduction: Transperineal prostate biopsy (TPB) is associated with a significantly lower risk of infectious complications as compared to the transrectal approach. In fact, the risk of infectious complications with TPB is so low that the utility of administering peri-procedure antibiotics with this procedure has come under question. Thus, we performed a systematic review and metanalysis to assess for differences in the rates of infectious complications (septic, non-septic, overall) after TPB performed with and without administration of antibiotic prophylaxis.

Methods: Three electronic databases (PubMed, EMBASE and MEDLINE) were searched, and studies were included if they included men who underwent TPB, were published after January 2000, included information on periprocedural antibiotic administration, and reported post-biopsy complications. Preferred Reporting Items for Systematic Reviews and Metanalyses and Agency for Healthcare Research and Quality guidelines were utilized.

Results: A total of 106 unique studies describing 112 cohorts of patients were identified where 98 (37,805 men) received antibiotic prophylaxis and 14 (4,772 men) did not receive antibiotic prophylaxis. All men were included in the analysis of septic complications. In total there were 19 (0.05%) episodes of sepsis in the group of antibiotics. The event rate was similar to the no antibiotic group, in which only 4 (0.08%) patients experienced sepsis (p=0.2). For overall infections (septic plus non-septic), there were 58 (1.22%) events versus 403 (1.35%) among 29,880 men with evaluable data who did and did not receive antibiotic prophylaxis, respectively (p=0.8). Restricting to our analysis to studies with a comparable number of biopsy cores, there remained no difference in the rates of sepsis between groups. In this analysis we also observed a small but statistically significant lower risk of infectious complications with antibiotic administration (0.55 vs. 1.22%, p<0.01).

Conclusions: The likelihood of septic infections after TPB is low with and without antibiotic prophylaxis. The omission of periprocedural antibiotics with this procedure stands to benefit patients by avoiding potential drug reactions. Furthermore, this practice is in line with calls throughout the medical community for improved antibiotic stewardship.

Source of Funding: Jim Hu receives research support from the Dow Wallace Fund of the New York Community Trust and salary support from NIH CA241758, PCORI CER-2019C1-15682 and CER-2019C2-17372.