Clinical Scorecard: Evaluation of Transperineal Prostate Biopsy Without Antibiotic Prophylaxis and Perioperative Bacteriuria Screening: A Single-Center Retrospective Study

At a Glance

Key Highlights

• Transperineal biopsy reduces sepsis risk compared to transrectal approach, potentially allowing omission of antibiotic prophylaxis.
• Retrospective analysis of 636 patients undergoing transperineal biopsy without antibiotic prophylaxis showed safety regarding infectious complications.
• Avoiding antibiotic prophylaxis may reduce antibiotic overuse and resistance, addressing a significant public health concern.

Guideline-Based Recommendations

Diagnosis

• Use transperineal approach for prostate biopsy as recommended by EAU guidelines to reduce infection risk.
• Perform biopsy based on pathological PSA, DRE, or MRI findings.
• Exclude patients on anticoagulants (except aspirin) or with contraindications prior to biopsy.

Management

• Omit antibiotic prophylaxis for transperineal prostate biopsy given low infection risk.
• Use local anesthesia with periprostatic nerve block; add sedation for MRI fusion biopsies.
• Perform antiseptic disinfection with 7.5% Povidone-Iodine solution before biopsy.

Monitoring & Follow-up

• Monitor patients post-procedure for gross hematuria and ability to void before discharge.
• Collect follow-up data via chart review to identify any infectious or other complications.

Risks

• Potential infectious complications are low with transperineal biopsy without antibiotics but should be monitored.
• Selection and follow-up bias may affect retrospective study results.
• Patients on certain anticoagulants require medication pause prior to biopsy to reduce bleeding risk.

Patient & Prescribing Data

636 patients undergoing transperineal prostate biopsy without antibiotic prophylaxis

Omission of antibiotic prophylaxis did not increase postinterventional infectious complications, supporting safe reduction of antibiotic use.

Clinical Best Practices

• Adopt transperineal biopsy approach to minimize infectious complications compared to transrectal route.
• Avoid routine antibiotic prophylaxis in transperineal prostate biopsy to reduce antibiotic resistance risk.
• Ensure thorough antiseptic skin preparation with Povidone-Iodine before biopsy.
• Use local anesthesia with periprostatic nerve block; consider sedation for MRI fusion biopsies.
• Screen patients carefully for contraindications including anticoagulant use and pause medications as needed.
• Monitor patients post-biopsy for complications before discharge.

References

• EAU Guidelines on Prostate Biopsy
• Basourakos et al. Meta-analysis on Antibiotic Prophylaxis
• Castellani et al. Meta-analysis on Antibiotic Prophylaxis
• Hulscher et al. Review on Antibiotic Prescribing in Hospitals