Comparing infective complications from transrectal ultrasound guided prostate biopsy following transition to single dose oral ciprofloxacin prophylaxis.

PURPOSE

To examine the incidence of infective complications post Transrectal Ultrasound Guided Prostate Biopsy (TRUSPB), after transition to preoperative administration of single dose oral ciprofloxacin.

MATERIALS AND METHODS

A retrospective study of 766 consecutive patients undergoing TRUSPB at St Vincent's Hospital Melbourne (2002-2016). Antibiotic prophylaxis between 2002-2014 consisted of 3 days of perioperative oral norfloxacin±intravenous (IV) antibiotics (Group A, n=687). From November 2014 patients received a single dose of oral 750 mg ciprofloxacin pre-biopsy (Group B, n=79), to align with the American Urological Association (AUA) and a Cochrane Database Systematic Review on Antibiotic Prophylaxis for TRUSPB. Groups were compared for all postoperative complications requiring representation and/or readmission within 30 days of biopsy.

RESULTS

In Group A, 10 of 687 patients (1.5%) re-presented with post-procedural fever (temperature >38℃), requiring readmission and IV antibiotic treatment, compared to 4 of the 79 patients (5.1%) in Group B (p=0.02). Positive blood cultures were isolated in 0.9% (n=6, Group A) versus 3.8% (n=3, Group B) (p=0.02). The 4 infectious readmissions in Group B had no prior genitourinary infections, no recent travel and all had a Charlson Comorbidity Index scores <2. Two patients in Group B cultured sensitive to ciprofloxacin despite receiving preoperative ciprofloxacin.

CONCLUSIONS

Antibiotic prophylaxis using single dose ciprofloxacin is associated with higher infective complications post TRUSPB. The episodes of ciprofloxacin sensitive bacteraemia in Group B suggest consideration of a longer course of perioperative antibiotic prophylaxis.