The addition of peri-operative gentamicin with ciprofloxacin reduces infection and sepsis rates post transrectal prostate biopsy

Objective

Despite the advent of transperineal (TP) biopsy and reduced risk of infective complications, transrectal ultrasound-guided (TRUS) prostate biopsy is still widely performed worldwide. The accepted prophylactic antibiotic is usually a single agent oral fluoroquinolone; however, this approach is beset by growing antibiotic resistance. The aim of this study was to assess whether the addition of intravenous gentamicin (2 mg/kg or at least 160 mg), immediately prior to biopsy, in conjunction with routine ciprofloxacin prophylaxis, reduced infection and sepsis rates post TRUS biopsy.

Method

Six hundred fifty-eight patients underwent TRUS biopsy at our center from 2017 to 2022, of whom 648 had data sufficient for analysis. We performed a retrospective analysis focusing on patient demographics (age, BMI, diabetes status), biopsy parameters, and outcomes of sepsis and urinary tract infection . Patients were recorded as developing sepsis if they required hospital admission for intravenous antibiotics. Fisher's exact test was employed for categorical variables, while the Student's t test was utilized for continuous variables for statistical significance.

Results

The rate of sepsis was 3.9% in the ciprofloxacin-only group, versus 0% in the ciprofloxacin plus gentamicin group (P value = 0.03). Overall aggregated post-TRUS infection rates was also 0% in the ciprofloxacin plus gentamicin group (P value = 0.005). We found no associated between infection and secondary risk factors.

Conclusion

The administration of 2 mg/kg intravenous gentamicin with oral ciprofloxacin prophylaxis reduces infection and sepsis rates post TRUS biopsy.