INTRODUCTION AND OBJECTIVE: There is no general agreement on the best antibiotic regimen for the prophylaxis of infective complications after transrectal needle biopsy of the prostate. Recently, the incidence of fluoroquinolone resistant infections has increased and infective complications after prostate biopsy may develop in 2.4% to 7.7% of cases. Our objective was to evaluate the efficacy of a single intravenous (I.V.) dose of piperacillin-tazobactam (P-T) as prophylaxis in transrectal ultrasound (TRUS) guided prostate biopsy. METHODS: From November 2007 to October 2008 we prospectively evaluated 226 consecutive men who underwent TRUS-guided prostate needle biopsy because of an abnormal digital rectal examination, prostate specific antigen >4.0 ng/ml or both. Exclusion criteria were recent use of antibiotics, indwelling urinary catheter and/or positive urine cultures. All patients received cleansing enemas the night before and the morning of the procedure. A clinic nurse administered a single I.V. dose of piperacillin 4g/tazobactam 500mg 15 to 30 minutes before biopsy. The end-point was fever (>=38degreeC), classified as immediate if developed during the first 72 hours; or late if occurred between 72 hours and 2 weeks after biopsy. Prospective monitoring of post-biopsy complications (fever, hematuria, hematospermia, acute urinary retention, rectal bleeding) was performed with a questionnaire that patients had to answer at home and return to our department at the end of follow-up period (2 weeks after biopsy). RESULTS: 183 men were eligible for analysis. A mean of 14 biopsy cores per patient was obtained. The mean prostate volume was 49 cc. Prostate cancer was detected in 75 cases (41%). None developed immediate fever. Two patients (1.1%) experienced late fever. The first one had acute urinary retention and two weeks later developed fever. The second patient had urinary tract infection and fever one week after the biopsy. Both patients required to be admitted to the hospital and were successfully treated with I.V. antibiotics without further complications. No mortality occurred in this series. CONCLUSIONS: A single I.V. dose of P-T before transrectal needle biopsy of the prostate is effective for the prophylaxis of febrile complications. This option should be considered in centers where fluoroquinolone resistance is increasing. Prospective, randomized trials are necessary to confirm these findings.
Aguilar-Davidov, B., Gonzalez-Ramirez, A., Castillejos-Molina, R., Sotomayor, M., Feria-Bernal, G., & Rodriguez-Covarrubias, F. (2009). A SINGLE DOSE OF PIPERACILLIN-TAZOBACTAM FOR THE PROPHYLAXIS OF FEBRILE COMPLICATIONS IN TRANSRECTAL NEEDLE BIOPSY OF THE PROSTATE. Journal of Urology, 181(4S), 802–802. https://doi.org/10.1016/s0022-5347(09)62233-3