Comparing infective complications from transrectal ultrasound guided prostate biopsy following transition to single dose oral ciprofloxacin prophylaxis

PURPOSE: To examine the incidence of infective complications post Transrectal Ultrasound Guided Prostate Biopsy (TRUSPB), after transition to preoperative administration of single dose oral ciprofloxacin. MATERIALS AND METHODS: A retrospective study of 766 consecutive patients undergoing TRUSPB at St Vincent's Hospital Melbourne (2002–2016). Antibiotic prophylaxis between 2002–2014 consisted of 3 days of perioperative oral norfloxacin±intravenous (IV) antibiotics (Group A, n=687). From November 2014 patients received a single dose of oral 750 mg ciprofloxacin pre-biopsy (Group B, n=79), to align with the American Urological Association (AUA) and a Cochrane Database Systematic Review on Antibiotic Prophylaxis for TRUSPB. Groups were compared for all postoperative complications requiring representation and/or readmission within 30 days of biopsy. RESULTS: In Group A, 10 of 687 patients (1.5%) re-presented with post-procedural fever (temperature >38℃), requiring readmission and IV antibiotic treatment, compared to 4 of the 79 patients (5.1%) in Group B (p=0.02). Positive blood cultures were isolated in 0.9% (n=6, Group A) versus 3.8% (n=3, Group B) (p=0.02). The 4 infectious readmissions in Group B had no prior genitourinary infections, no recent travel and all had a Charlson Comorbidity Index scores <2. Two patients in Group B cultured Escherichia coli sensitive to ciprofloxacin despite receiving preoperative ciprofloxacin. CONCLUSIONS: Antibiotic prophylaxis using single dose ciprofloxacin is associated with higher infective complications post TRUSPB. The episodes of ciprofloxacin sensitive E. coli bacteraemia in Group B suggest consideration of a longer course of perioperative antibiotic prophylaxis.