Comparison of Antibiotic Prophylaxis Regimens for Preventing Prostatitis After Transrectal Ultrasound-Guided Prostate Biopsy.

BACKGROUND

Transrectal ultrasound (TRUS)-guided prostate biopsy is a common way to find prostate cancer, but it can lead to infections, including sepsis. Fluoroquinolones have historically served as a means of antibiotic prophylaxis; however, escalating resistance has diminished their efficacy, thereby requiring alternative prophylactic approaches.

OBJECTIVE

To compare infectious outcomes after TRUS-guided prostate biopsy across various antibiotic prophylaxis regimens and to evaluate the efficacy of single-dose intramuscular (IM) ertapenem and amikacin.

METHODS

This retrospective observational study encompassed patients who underwent TRUS-guided prostate biopsy from January 2015 to June 2025 at two hospitals in Lebanon. We looked at the patients' demographics, clinical characteristics, laboratory data, antibiotic prophylaxis regimens, and post-biopsy infectious complications. We used bivariate analysis and multivariable logistic regression to find links between prophylaxis strategies and the risk of infection.

RESULTS

There were 209 patients in total, with an average age of 66.7 years and an average prostate-specific antigen level of 18.2 ng/mL. In total, 12.9% of patients had infections after the biopsy. Patients who received single-dose IM ertapenem, either alone or in combination with fluoroquinolones, did not experience any infections. The infection rate for patients who got a single dose of IM amikacin was 3.8%, while the rate for patients who got fluoroquinolone monotherapy was 26%. Single-dose IM ertapenem or amikacin was linked to a lower risk of infection than fluoroquinolone-based prophylaxis (p < 0.05). There was no meaningful distinction between ertapenem and amikacin, nor between single-agent and combination regimens. Older age and a history of positive urine culture were strongly linked to post-biopsy infection.

CONCLUSION

A single dose of IM ertapenem or amikacin appears to be associated with a lower risk of infections after a TRUS-guided prostate biopsy. They may represent a potential prophylactic alternative to fluoroquinolone-based regimens, especially in places where routine rectal culture-guided prophylaxis is not done.