Kevin B. Ginsburg, Johnathan Drevik, Jared P. Schober, Alberto A. Castro Bigalli, Jeffrey L. Ellis*, Avery Braun, Kaynaat Syed, Philadelphia, PA, John Danella, Danville, PA, Serge Ginzburg, Philadelphia, PA, Laurence Belkoff, Bala Cynwyd, PA, Adam C. Reese, Philadelphia, PA, Jeffrey Tomaszewski, Camden, NJ, Edouard Trabulsi, Phiadelphia, PA, Eric A. Singer, New Brunswick, NJ, Bruce Jacobs, Pittsburgh, PA, Jay D. Raman, Hershey, PA, Thomas Guzzo, Robert G. Uzzo, Marc C. Smaldone, Andres F. Correa, Philadelphia, PA
Introduction: There is an emerging epidemic of multi-drug resistant organisms resulting from poor antibiotic stewardship. Transperineal (TP) prostate biopsy has a significant lower incidence of infectious related complications compared with transrectal prostate biopsy. Despite the improved infectious profile with TP biopsy, the safety of omission of pre-procedure antibiotics for men undergoing TP biopsy has not been well established. We aimed to investigate if the omission of antibiotics was associated with increased infectious related complications in men undergoing TP biopsy.
Methods: We reviewed the Pennsylvania Urologic Regional Collaborative (PURC) registry for men undergoing TP biopsy. Men were classified as those receiving any prophylactic antibiotic vs. those that did not. All patients received a local skin antiseptic preparation. Infectious outcomes of interest included post-biopsy fever, sepsis, or UTI within 30 days of the biopsy. Additional outcomes of interest include emergency room visit or readmission within 30 days of the biopsy. Proportions were compared with the Fisher’s exact test and continuous measures were compared with the Wilcoxon rank sum test.
Results: We identified 405 men at 7 institutions in PURC that underwent a TP biopsy from May 2015 to June 2021, of which 282 men (70%) did not receive antibiotic prophylaxis and 123 (30%) received antibiotic prophylaxis. There were a similar number of biopsy cores sampled between men that did not receive and received antibiotic prophylaxis (12 cores vs. 13 cores, p=0.641) and a similar distribution of age with most men in the age category of 60-69 years old (48% vs. 64%, p=0.166). There were no infectious complications, including post-biopsy fever, sepsis, or UTI, for men undergoing TP biopsy without (0%) or with antibiotic prophylaxis (0%). Additionally, there were no significant difference in post-biopsy ER visits among men without antibiotic prophylaxis compared with men receiving prophylaxis (0.71% vs. 0.81, p=0.664). Finally, there were no hospitalizations among the 405 men undergoing TP biopsy without or with antibiotic prophylaxis.
Conclusions: Infectious complications after TP biopsy are rare. The omission of antibiotics did not increase the incidence of UTI, fever, or sepsis. These results suggest urologists may omit prophylactic antibiotics in appropriately selected patients in efforts to improve antimicrobial stewardship.
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