Abstract
Purpose
To investigate the effect of pre-biopsy rectal swab and urine screening combined with a risk-adapted antibiotic treatment strategy on reducing post-biopsy infections (PBIs) following multiparametric magnetic resonance imaging (mpMRI)/ transrectal ultrasound (TRUS) fusion-targeted transrectal prostate biopsy (TRPBx).
Methods
1182 Patients undergoing mpMRI-TRUS fusion TRPBx between June 2017 and February 2024 were included. Patients were screened for rectal extended-spectrum beta-lactamase (ESBL)/multi-resistant gram-negative (MRGN) and urinary pathogens. Standard-risk patients (rectal non-ESBL/MRGN-carriers) either received Cefuroxime (2017–2020) or Ceftriaxone (2020–2024) intravenously before biopsy. For high-risk patients (rectal ESBL/MRGN-carriers) intravenous Ertapenem was used. Patients with positive urine cultures received oral targeted prophylaxis. PBIs were the primary outcome of the study. We used uni- and multivariate logistic regression analysis (MLRA) to reveal predictors for the main outcome.
Results
Rectal ESBL/MRGN prevalence was 6.3%. For standard-risk patients, PBI-rates were 8.1% and 0.24% for Cefuroxime and Ceftriaxone (p < 0.0001), respectively. Only 1.7% of high-risk patients treated with Ertapenem developed PBI. On MLRA, Cefuroxime (OR 19.3, 95%-CI: 6.96–68.1), Ciprofloxacin (OR 35.5, 95%-CI: 7.91–160), oral targeted antibiotics (OR 20.2, 95%-CI: 0.97–157) (reference Ceftriaxone, all p < 0.001) and prostate volume (OR 1.01, 95%-CI: 1.00-1.03, p = 0.033) were significant predictors for PBI whereas Ertapenem (OR 3.28 95%-CI: 0.17–22.6, p = 0.3) was not.
Conclusion
By integrating rectal swab ESBL/MRGN and urine screening, we developed a tailored antibiotic treatment strategy, resulting in low PBI-rates following TRPBx. Carbapenem-based treatment of high-risk patients is crucial. Ceftriaxone should be considered for routine use in standard-risk patients and shows comparable PBI-rates to the transperineal approach.