Infection Rate after Transperineal Prostate Biopsy with and without Prophylactic Antibiotics: Results from a Systematic Review and Meta-Analysis of Comparative Studies

Abstract

Purpose: We performed a systematic review comparing the incidence of infectious complications following transperineal ultrasound-guided prostate biopsy (TPB) in cases utilizing antibiotic prophylaxis (AP) vs cases not utilizing antibiotic prophylaxis (NAP). Materials and Methods: The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and expressed as risk ratio (RR). RR higher than 1 indicates an increased risk of complication in patients undergoing TPB without antibiotics. Statistical significance was set at p <0.05 and 95% CI. Results: A total of 1,748 papers were retrieved. After the screening process, 8 studies were included in the quantitative analysis (4 retrospective, and 4 prospective and nonrandomized), reporting on 3,662 patients. A total of 2,368 patients underwent TPB utilizing AP and 1,294 underwent TPB utilizing NAP. The pooled rates of post-biopsy fever from 6 available studies reporting this parameter were 0.69% in the AP group and 0.47% in the NAP group (RR: 1.02, 95% CI: 0.02e44.55, p[0.99). The pooled rates of post-biopsy genitourinary infections from 8 available studies reporting this parameter were 0.11% in the AP group and 0.31% in the NAP group (RR: 2.09, 95% CI: 0.54e8.10, p[0.29). The pooled rates of post-biopsy sepsis over 8 studies reporting this parameter were 0.13% in the AP group and 0.09% in the NAP group (RR: 1.09, 95% CI: 0.21e5.61, p[0.92). The pooled rates of post-biopsy readmission for infections over 8 studies reporting this parameter were 0.13% in the AP group and 0.23% in the NAP group (RR: 1.29, 95% CI: 0.31e5.29, p[0.73). Death due to post-biopsy sepsis did not occur in any study. Conclusions: This systematic review found no significant difference in infection rate, fever, sepsis or readmission rate after TPB between those cases utilizing AP and those cases without AP.

Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible

“…Indeed, there is recent systemic analysis suggesting that the rate of infectious complications post TPB with and without prophylactic antibiotics does not significantly differ. 32 Reported rates of infectious complications post TPB are as low as 0%. 3,33 On the contrary, our infectious complications comprising of two out of 48 patients (4.2%), was remarkably high.…”

“…Given the improved infectious complication rates with TPB, and positive prior experience without prophylactic antibiotics, we adopted this approach for our biopsies. Indeed, there is recent systemic analysis suggesting that the rate of infectious complications post TPB with and without prophylactic antibiotics does not significantly differ 32 …”

Is antibiotic prophylaxis still mandatory for transperineal prostate biopsy? Results of a comparative study

“…Castellani D et al 28 presented a Systematic Review and Meta-Analysis of comparative studies in which TP-PB was performed with or without antibiotics, reporting a similar pooled rate of UTI after TP-PB, estimated to 0.11% in the AP group and 0.31% in the group without AP (RR: 2.09, 95% CI: 0.54–8.10, P = 0.29).…”

Implications and effects of COVID-19 on diagnosis and management of prostate cancer

“…The peak of COVID-19 disruption on the diagnostic pathway of PCa caused a 59.7% drop in prostatespecific antigen (PSA) testing and a decline in the number of centres offering biopsies [6]. A 26% decline for local anaesthetic transperineal (LATP), 59% decline for general anaesthetic transperineal (GATP), and 58% decline for local anaesthetic transrectal (LATRUS) biopsies were seen respectively in the UK [7,8]. The extant literature suggests that both LATP and GATP biopsies lead to fewer complications due to infection or urosepsis, without requiring additional protective measuressuch as the use of prophylactic antibiotics.…”

“…These patients should all receive a negative COVID-19 screening result prior to the procedure. Should COVID-19 remain an endemic threat, LATP biopsies may thus pose less risk to all involved parties than other biopsy methods [7,9,10]. These patients should ideally be tested and screened negative for COVID-19 prior to their procedures to prevent spread, depending on local COVID-19 protocols, resources and insurance coverage.…”