In men without infection risk factors, antibiotic prophylaxis before transperineal prostate biopsy could be omitted without increasing the rate of serious infections, according to investigators.
Maciej Jacewicz, MD, of the Oslo University Hospital in Norway, and colleagues performed the first randomized trial comparing infection rates between 277 men receiving and 277 men not receiving antibiotic prophylaxis (intramuscular or intravenous 1.5 g cefuroxime) before transperineal biopsy. Men with recent or recurrent urinary tract infection, indwelling urinary catheter, immunodeficiencies, high risk of infective endocarditis, or history of thromboembolic disease were excluded.
No patients in either group experienced the primary outcome of sepsis or urinary tract infection requiring hospitalization within 2 months of biopsy, Dr Jacewicz’s team reported in The Lancet Infectious Diseases. The secondary outcome of urinary tract infections without hospitalization occurred in 0.4% of the prophylaxis group and 1.1% of the non-prophylaxis group within 7-21 days of biopsy. The absolute risk difference was only 0.73%, however. The investigators calculated that 137 patients would need to receive antibiotic prophylaxis before transperineal prostate biopsy to avoid 1 post-biopsy infection.
According to Dr Jacewicz’s team, “it might be possible to omit antibiotic prophylaxis in patients without risk factors for infection. Such a strategy would decrease the unnecessary use of antibiotics and potentially reduce the development of antibiotic resistance.”
In an accompanying editorial, Ola Bratt, MD, PhD, of the University of Gothenburg in Sweden, praised the trial and stated that the findings, coupled with observational data reaching similar conclusions, are “sufficiently strong” to omit antibiotic prophylaxis before transperineal prostate biopsy in patients without risk factors for a post-biopsy infection.
“The combined evidence from the hitherto published studies suggests that continued routine use of antibiotic prophylaxis while waiting for confirmatory study results might do more harm than good,” he wrote.
Dr Bratt noted that future research is needed to assess the role and choice of antibiotic prophylaxis before transperineal prostate biopsy in patients who do have risk factors for post-biopsy infection.
Jacewicz M, Günzel K, Rud E, et al. Antibiotic prophylaxis versus no antibiotic prophylaxis in transperineal prostate biopsies (NORAPP): a randomised, open-label, non-inferiority trial. Lancet Infect Dis. 2022 Oct;22(10):1465-1471. doi:10.1016/S1473-3099(22)00373-5
Bratta O. Is it time to abandon routine antibiotics for transperineal prostate biopsy? Lancet Infect Dis. 2022 Oct;22(10):1403-1404. doi:10.1016/S1473-3099(22)00419-4