Monoprophylaxis With Cephalosporins for Transrectal Prostate Biopsy After the Fluoroquinolone-Era: A Multi-Institutional Comparison of Severe Infectious Complications.

Mike Wenzel,Philipp Mandel,Maria N Welte,Clarissa Wittler,Felix Kh Chun,Samuel Doryumu,Niklas Westhoff,Maximilian C Kriegmair,Jost Von Hardenberg,Thomas Höfner,Benedikt Hoeh,Maurice S Michel,Jonas Herrmann

doi:10.3389/fonc.2021.684144

Abstract

BackgroundTo compare severe infectious complication rates after transrectal prostate biopsies between cephalosporins and fluoroquinolones for antibiotic monoprophylaxis.Material and MethodsIn the multi-institutional cohort, between November 2014 and July 2020 patients received either cefotaxime (single dose intravenously), cefpodoxime (multiple doses orally) or fluoroquinolones (multiple-doses orally or single dose intravenously) for transrectal prostate biopsy prophylaxis. Data were prospectively acquired and retrospectively analyzed. Severe infectious complications were evaluated within 30 days after biopsy. Logistic regression models predicted biopsy-related infectious complications according to antibiotic prophylaxis, application type and patient- and procedure-related risk factors.ResultsOf 793 patients, 132 (16.6%) received a single dose of intravenous cefotaxime and were compared to 119 (15%) who received multiple doses of oral cefpodoxime and 542 (68.3%) who received fluoroquinolones as monoprophylaxis. The overall incidence of severe infectious complications was 1.0% (n=8). No significant differences were observed between the three compared groups (0.8% vs. 0.8% vs. 1.1%, p=0.9). The overall rate of urosepsis was 0.3% and did not significantly differ between the three compared groups as well.ConclusionMonoprophylaxis with third generation cephalosporins was efficient in preventing severe infectious complications after prostate biopsy. Single intravenous dose of cefotaxime and multiday regimen of oral cefpodoxime showed a low incidence of infectious complications <1%. No differences were observed in comparison to fluoroquinolones.

Highlights

Prostate cancer, the most common cancer in men worldwide, is diagnosed with prostate biopsies [1]
Studies comparing a monotherapeutic prophylaxis with cephalosporins vs. fluoroquinolones in a homogenous cohort are still pending [13]. We addressed this void and relied on a multi-institutional prostate biopsy database of two tertiary care university hospitals
Prior to transrectal prostate biopsy, a periprostatic local anesthesia was injected under ultrasoundguidance, as recommended [2]

Summary

Introduction

The most common cancer in men worldwide, is diagnosed with prostate biopsies [1]. Two different applicable biopsy approaches are available, a transrectal and transperineal approach [2]. Several studies reported that cancer detection rates by systematic biopsies are comparable between both approaches [3, 4]. Regarding infectious rates, some studies suggest that the transperineal approach is associated with lower rates of infectious complications, while other report comparable infectious rates [4,5,6]. The transrectal approach is still used worldwide and guidelines do not recommend one approach over the other, since the advantage of the transrectal approach is the quick and easy performance in an outpatient setting under local anesthesia, while a transperineal biopsy is widely performed under general anesthesia [2, 4]. To compare severe infectious complication rates after transrectal prostate biopsies between cephalosporins and fluoroquinolones for antibiotic monoprophylaxis

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