Login to Access Video or Poster Abstract: MP38-06
Sources of Funding: Ipsen and Tolmar

Introduction

Transrectal biopsy is plagued by an increasing rate of serious infection, despite use of recommended fluoroquinolone antibiotics. Transperineal biopsy (TPB), on the other hand, has been associated with an exceedingly low rate of serious infection. The aim of this study was to determine the rate of hospital admissions for infection after transperineal biopsy of prostate.

Methods

Patients underwent transperineal biopsy of the prostate (TPB) between May 2012 and October 2016 by a private group urology practice, at multiple hospitals across Melbourne. A standard brachytherapy template grid was used, taking a number of samples from left and right prostate posterior, mid and anterior regions. Some patients had extra core biopsies taken from target areas suspicious of cancer identified on prior MRI. Data collected from these patients were entered into an ethics approved prospective database including prophylactic antibiotics used and post operative complications.

Results

1359 consecutive patients underwent TPB. Initially patients were treated with quinolone prophylaxis and then later patients received cephazolin only. 1030 (75.8%) had single dose IV cephazolin, 388 (28.6%) had an oral quinolone with IV cephazolin, 107 (7.9%) had IV ceftriaxone and 2 (0.1%) had IV clindamycin, 2 (0.1%) had IV meropenem and 1 (0.1%) had IV vancomycin prophylaxis. Routine practice shifted from use of quinolones to cephazolin during the study period. 25 (1.8%) patients developed acute urinary retention and 1 patient was treated in the community with oral antibiotics for prostatitis. No patients were readmitted to hospital with infection.

Conclusions

Sepsis post TPB is an exceedingly rare complication, with a 0% rate in this large prospective multicentre cohort. It is safe to use single dose cephazolin only as antibiotic prophylaxis prior to TPB, negating the need for quinolones. This study supports the current Australian Therapeutic Guidelines recommendation for TPB prophylaxis. Whether any antibiotic prophylaxis is needed at all for TPB is the subject of a future study.

Funding

Ipsen and Tolmar