Prophylactic antibiotic use in transrectal prostatic needle biopsy; a randomized control trial of Targeted versus Empirical antibiotic prophylaxis

Abstract

Background: Prostate biopsy is one of the most performed urological procedures. It is a generally safe procedure, however, there has been increasing incidence of life-threatening infective complications such as sepsis due to a global rise in antibiotic resistance.

Methodology: This study aimed to determine whether targeted antibiotic prophylaxis using rectal swab MCS-directed antibiotics is more effective than empirical antibiotic prophylaxis in preventing infective complications after transrectal prostatic needle biopsy at a Nigerian Teaching Hospital. Ninety-two consenting patients were prospectively randomized into 2 equal arms using a computer-generated random sequence. Forty-six patients received targeted antibiotic prophylaxis based on rectal swab MCS, while the remainder received empirical antibiotic prophylaxis as per local protocol. All patients underwent sextant transrectal prostatic needle biopsy and were subsequently followed up for 1months to assess for infective complications. The data were analyzed using SPSS version 21. Statistical significance was set at P ≤0.05.

Results: The average age of the patients studied was 68.3yrs (48-91±8.3yrs). Both groups were comparable at baseline. Overall, there were 7(7.6%) cases of infectious complications. Most of these complications occurred in the empirical prophylaxis group (6 (13 %) vs. 1 (2 %), P– 0.049). These were also more severe than those in the targeted arm.

Conclusions: Targeted antibiotic prophylaxis was associated with a significant decrease in the incidence of infectious complications compared with empirical antibiotic prophylaxis after transrectal prostate needle biopsy. This method should be considered in patients at a high risk of infective complications.