Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective randomized trial of cefuroxime versus piperacillin/tazobactam.

OBJECTIVE

To compare the clinical and microbiological outcome of a single-dose administration of cefuroxime or combined piperacillin/tazobactam (PT) after transrectal prostatic core-biopsy (TPB) in a prospective, randomized, open-label study.

PATIENTS AND METHODS

Of 111 eligible men consecutively undergoing ultrasonographically guided TPB, 56 received 1.5 g cefuroxime and 55 received 4.5 g PT intravenously 20 min before the procedure. The anterior rectal wall was cleaned with an antiseptic swab and four biopsies were taken. Urine and blood cultures were evaluated before the procedure and again after 48 h, and oral temperature and symptoms recorded for 72 h after TPB.

RESULTS

A clinically successful outcome (no symptoms to indicate urinary or systemic sepsis or pyrexia > or = 37.5 degrees C after TPB) was achieved in 100 of 108 men (92.6%), of whom 51 received cefuroxime and 49 PT. Microbiological success (no bacteriuria > 10(5) organisms/mL, or bacteraemia, after TPB) was observed in 98 of 103 men (95%), of whom 48 received PT and 50 cefuroxime. Bacteriuria was present 48 h after TPB in 5% of the men. One man randomized to receive cefuroxime became bacteraemic (with Escherichia coli) and required hospital admission. Four of the five microbiological failures were caused by organisms sensitive to the administered antimicrobial agent. No anaerobic organisms were cultured. The most common adverse event recorded was transient diarrhoea, reported by 16 men receiving PT and two receiving cefuroxime.

CONCLUSION

With this prophylactic regimen, there was no significant difference in outcome between the groups. Most of the organisms isolated were sensitive to the administered antimicrobial agent. Thus, further reductions in sepsis after TPB may be achieved by the administration of additional oral antimicrobial prophylaxis.