Leboutte Francois, Schykowski Tim, Van de Plas Jeroen, Lemmer Oscar, Neisius Andreas
Department of Urology, Krankenhaus der Barmherzigen Brüder Trier, Medical Campus Trier of the Johannes Gutenberg-University Mainz, Trier, Germany.
Department of Urology, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany.
World J Urol. 2025 Jun 19;43(1):378. doi: 10.1007/s00345-025-05672-8.
Although the pursuit of effective and safe early detection methods for prostate cancer has led to advancements in non-invasive tools, there are approximately one million prostate biopsies per year performed annually in the EU [11]. The use of the transperineal approach to prostate biopsy is increasing because it offers a significantly reduced incidence of post-biopsy sepsis complications compared to transrectal biopsies and therefore is the recommended approach in the European Association of Urology guidelines. However, the consensus on the standard of care for antibiotic prophylaxis in some or all transperineal biopsy cases is only beginning to be established. As with transrectal biopsies, there are concerns about antibiotic stewardship, antibiotic side effects and labor and material costs associated with prophylaxis.
This retrospective study analyzed 636 patients who underwent transperineal prostate biopsies without the use of antibiotic prophylaxis between January 2019 and August 2020. The primary endpoint was the rate of postinterventional infectious complications, with secondary endpoints including the rate of general complications and associated risk factors.
The rate of all complications was 1.9%. There were 7/636 (1.1%) infectious complications, of which 3 (0.50%) were prostatitis, 1 (0.16%) was epididymitis, 2 (0.3%) were infections resulting in hospitalization and 1 (0.16%) urosepsis with ICU care. No identified risk factors were associated with infectious complications or post-interventional bleeding. Notably, the cohort was not systematically screened for bacteriuria before biopsy, and patients usually categorized as high risk for post-biopsy complications were not excluded. The rates of infectious complications and sepsis were lower than that reported for transrectal biopsies with antibiotic prophylaxis.
This study supports the relative safety of omitting antibiotic prophylaxis in transperineal prostate biopsies, showcasing a minimal infectious complication rate. The findings contribute to the ongoing discourse on antibiotic stewardship, emphasizing the need for judicious use to mitigate resistance, avoid allergic side effects and decrease the labor and material costs associated with transperineal prostate biopsy.
尽管对有效且安全的前列腺癌早期检测方法的追求推动了非侵入性工具的发展，但在欧盟，每年仍有约100万例前列腺活检[11]。经会阴途径进行前列腺活检的使用正在增加，因为与经直肠活检相比，它能显著降低活检后败血症并发症的发生率，因此是欧洲泌尿外科学会指南中推荐的方法。然而，对于部分或所有经会阴活检病例中抗生素预防的护理标准的共识才刚刚开始形成。与经直肠活检一样，人们对抗生素管理、抗生素副作用以及与预防相关的劳动力和材料成本存在担忧。
这项回顾性研究分析了2019年1月至2020年8月期间636例未使用抗生素预防措施进行经会阴前列腺活检的患者。主要终点是介入后感染并发症的发生率，次要终点包括一般并发症的发生率和相关危险因素。
所有并发症的发生率为1.9%。有7/636（1.1%）例感染并发症，其中3例（0.50%）为前列腺炎，1例（0.16%）为附睾炎，2例（0.3%）为需要住院治疗的感染，1例（0.16%）为需要重症监护病房护理的尿脓毒症。未发现与感染并发症或介入后出血相关的危险因素。值得注意的是，该队列在活检前未进行系统性的菌尿筛查，并且通常被归类为活检后并发症高风险的患者并未被排除。感染并发症和败血症的发生率低于有抗生素预防措施的经直肠活检报告的发生率。
本研究支持在经会阴前列腺活检中省略抗生素预防措施的相对安全性，显示出最低的感染并发症发生率。这些发现有助于正在进行的关于抗生素管理的讨论，强调明智使用抗生素以减轻耐药性、避免过敏副作用并降低与经会阴前列腺活检相关的劳动力和材料成本的必要性。
