title: Antibiotic prophylaxis in prostate biopsy. A comparative randomized clinical assay between ciprofloxacin, norfloxacin and chloramphenicol. Cephalosporins periprostatic injection: are really effective on infections following prostate biopsy? Prevention of urinary tract infection and sepsis following transrectal prostatic biopsy. Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Efficiency of short and long term antimicrobial therapy in transrectal ultrasound-guided prostate biopsies. Optimizing prophylactic antibiotic regimen in patients admitted for transrectal ultrasound-guided prostate biopsies: A prospective randomized study The impact of repeat biopsies on infectious complications in men with prostate cancer on active surveillance. Complications after prostate biopsy: data from SEER-Medicare. Prophylactic antibiotics reduce sepsis after biopsy of the prostate. Is urine culture routinely necessary before prostate biopsy? Bacterial sepsis following prostatic biopsy A prospective randomized trial of 1-day versus 3-day antibiotic prophylaxis for transrectal ultrasound guided prostate biopsy. Antibiotic prophylaxis for transrectal prostate biopsy: a prospective randomized study of tosufloxacin versus levofloxacin. Single-dose antibiotic prophylaxis in core prostate biopsy: Impact of timing and identification of risk factors. Antibiotic prophylaxis for transrectal needle biopsy of the prostate: a randomized controlled study Outcomes of fecal carriage of extended-spectrum β-lactamase after transrectal ultrasound-guided biopsy of the prostate. Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy. Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy--should we reassess our practices for antibiotic prophylaxis? Acute bacterial prostatitis after transrectal ultrasound-guided prostate biopsy: epidemiological, bacteria and treatment patterns from a 4-year prospective study. Prospective assessment of the efficacy of single dose versus traditional 3-day antimicrobial prophylaxis in 12-core transrectal prostate biopsy.
abstract: OBJECTIVE To compare , prospect ively , 4 different schemes of antibiotic prophylaxis previously to transrectal prostate biopsy . MATERIAL S AND METHODS 257 patients were r and omized in 4 groups : Group I : single dose of ciprofloxacin 2 hours before the procedure ; Group II : ciprofloxacin 3 days ; Group III : chloramphenicol 3 days ; and Group IV : norfloxacin 3 days . The complication rate was assessed in a blind way on the third and on the thirtieth days through a question naire . Groups were compared by the qui-square method and , in small sample s , by the Fisher method , with statistical significance of 95 % . RESULTS Complications index throughout the sample differed between the 4 groups of patients under study , being 3.1 % for group I , 2.1%for group II , 18.3 % for group III and 10.5 % for group IV . Schemes employing ciprofloxacin were statistically superior to those that used norfloxacin or chloramphenicol ( p < 0.05 ) . There was no difference between a single dose and 3 days of ciprofloxacin ( p > 0.05 ) . CONCLUSION Schemes using ciprofloxacin presented better results in prophylaxis previously to prostate biopsy . We recommend using a single dose of ciprofloxacin due to its posologic ease and low cost , associated with a therapeutic response equivalent to 3-day regimens Purpose To compare the antibiotic prophylaxis based on quinolone administered orally with a combination of cephalosporin administered periprostatically and a fluoroquinolone orally , in terms of post-prostate bioptic infectious complication rates in those men undergoing transrectal ultrasound-guided prostate biopsy ( TRUS gpb ) . Methods In a prospect i ve , r and omized , double-blind study , 150 consecutive patients were r and omized to receive 10 ml lidocaine 1 % in Group A and ceftriaxone 1 g diluted in a solution of 10 ml of lidocaine 1 % in Group B , before TRUS gpb . All signed the informed consent . The men were asked to grade the pain using a ten points visual analogue scale close after TRUS gpb . In a telephone interview at 3 and 6 days , they were asked about early and late complications , assessing rectal bleeding , urinary retection , fewer , haematuria , urethral bleeding and hematospermia . Results Of the 150 men enrolled , 135 , 70 in Groups A and 65 in Group B , completed the study . Four men ( 5.7 % ) in Group A developed sepsis after TRUS gpb requiring hospital admission and intravenous antibiotic treatment , while none in Group B. Escherichia coli was the only organism isolated . The mean pain score was 2.76 ± 1.69 and 1.73 ± 1.26 for Group A and B , respectively ( p = 0.08 ) . Complications , evaluated at 3 and 6 days after the procedure through a telephone interview , were similar in both Groups . Conclusions The antibiotic prophylaxis based on the combination of ceftriaxone administered periprostatically and ciprofloxacin orally is able to offer a best control on infections caused by fluoroquinolone-resistant E. coli Transrectal biopsy is one of the more popular methods for the diagnosis of prostatic cancer . However , there is disagreement as to whether the use of prophylactic antimicrobials decreases the incidence of fever and urinary tract infections , which may follow this procedure . A prospect i ve r and omized double-blind study involving 63 patients was instituted to determine the efficacy of carbenicillin indanyl sodium in reducing these complications . The protocol consisted of administration of 2 tablets of 4 times daily of a placebo or the treatment drug 24 hours before and after biopsy . Clean catch urine cultures were obtained 24 hours before biopsy and at 48 hours and 2 weeks after the procedure . Blood cultures were performed 15 minutes after biopsy . In addition , clinical parameters were monitored closely in the hospital for 48 hours after biopsy . A total of 48 patients was considered evaluable . Of 23 patients who received the study drug 2 ( 8.6 per cent ) had positive urine cultures at 48 hours compared to 9 of 25 ( 36 per cent ) from the placebo group . A similar result was observed from the 2-week culture data , in which 2 of 23 patients ( 8.6 per cent ) in the treatment group had positive urine cultures as opposed to 5 of 25 ( 20 per cent ) receiving the placebo .  Fever occurred in 48 per cent of the placebo and in 17 per cent of the carbenicillin groups . Our data indicate that prophylactic administration of carbenicillin indanyl sodium decreases the complications of fever and urinary tract infections following transrectal biopsy of the prostate BACKGROUND Infection is a serious adverse effect of  prostate biopsy ( P-Bx ) , and recent reports suggest an increasing incidence . OBJECTIVE The aim of this multinational multicentre study was to evaluate prospect ively the incidence of infective complications after P-Bx and identify risk factors . DESIGN , SETTING , AND PARTICIPANTS The study was performed as an adjunct to the Global Prevalence Study of Infections in Urology ( GPIU ) during 2010 and 2011 . Men undergoing P-Bx in participating centres during the 2-wk period commencing on the GPIU study census day were eligible . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline data were collected and men were question ed regarding infective complications at 2 wk following their biopsy . The Fisher exact test , Student t test , Mann-Whitney U test , and multivariate regression analysis were used for data analysis . RESULTS AND LIMITATIONS A total of 702 men from 84 GPIU participating centres worldwide were included . Antibiotic prophylaxis was administered prior to biopsy in 98.2 % of men predominantly using a fluoroquinolone ( 92.5 % ) . Outcome data were available for 521 men ( 74 % ) . Symptomatic urinary tract infection ( UTI ) was seen in 27 men ( 5.2 % ) , which was febrile in 18 ( 3.5 % ) and required hospitalisation in 16 ( 3.1 % ) . Multivariate analysis did not identify any patient subgroups at a significantly higher risk of infection after P-Bx . Causative organisms were isolated in 10 cases ( 37 % ) with 6 resistant to fluoroquinolones . The small sample size per participating site and in compared with other studies may have limited the conclusions from our study . CONCLUSIONS Infective complications after transrectal P-Bx are important because of the associated patient morbidity . Despite antibiotic prophylaxis , 5 % of men will experience an infective complication , but none of the possible factors we examined appeared to increase this risk . Our study confirms a high incidence of fluoroquinolone resistance in causative bacteria OBJECTIVE Prostate biopsy is a frequent diagnostic measure to detect prostatic conditions , including primarily prostate cancer . Its performance does not follow a pattern , mainly regarding preparation for the examination through antimicrobial prophylaxis . The aim of this study is to compare the efficiency of short and long term antimicrobial prophylaxis in transrectal ultrasound-guided prostate biopsies . MATERIAL S AND METHODS A clinical study was conducted with a total of 140 patients su bmi tted to prostate biopsy with transrectal ultrasonographic control . Patients were r and omly separated in two groups : Group 1 receiving norfloxacin 400 mg single dose before the procedure and Group 2 receiving norfloxacin 400 mg initiating before the procedure and then bid up to 6 doses . Efficiency control was determined by the incidence of urinary tract infection ( UTI ) and complications in both groups after statistical analysis . RESULTS The incidence of minor complications in our study was 75 % , consistent with data found in the literature . Among the patients with diagnosis of simple UTI , 23 % belonged to Group 1 and 8 % to Group 2 ( p=0.08 ) . Among the patients with complicated UTI , 37 % belonged to Group 1 and none belonged to Group 2 ( p=0.44 ) . CONCLUSIONS Several advances made transrectal ultrasound-guided prostate biopsies a useful and safe diagnostic tool in the workup of urologic patients . There is no optimal prophylactic preparation to the performance of this procedure . Long term antimicrobial prophylaxis presents a trend toward lower incidence of infectious complications Background Transrectal ultrasound-guided prostate biopsies ( TRUSBx ) , in spite of being one of the most frequently performed urological office procedures , are associated with a spectrum of complications , most significantly including infection . The aim of the study is to evaluate the prevalence of fluoroquinolone-resistant bacteria in rectal swabs from our local population prior to TRUSBx and to identify risk factors among a patient population harboring fluoroquinolone-resistant organisms . Methods We prospect ively included 541 men who were su bmi tted for TRUSBx in our center from March 2011 to June 2015 . The indications for TRUSBx were an elevated prostate-specific antigen level and /or abnormal digital rectal exam . All patients were r and omly divided into two groups : Group 1 ( n = 279 cases ) who received st and ard empirical prophylactic antibiotics and Group 2 who received targeted prophylaxis based on a rectal swab culture and susceptibility result . Differences in risk factors between quinolone-resistant and nonresistant patients were compared . Univariate and multivariate analyses were performed to identify independent potential risk factors associated with fluoroquinolone-resistant rectal flora . Results Sixteen out of 271 men developed infectious complications after TRUSBx in the group receiving st and ard empirical prophylaxis ( 5.7 % ) . No men in the group who received targeted prophylactic antibiotic guided by rectal swab developed infectious complications . Among the 262 patients who underwent prebiopsy rectal swab cultures , 76 men ( 29 % ) displayed fluoroquinolone-resistant rectal flora ( 29 % ) . In the multivariate analysis , a history of antibiotic exposure before prostate biopsy was the only independent factor associated with an increased risk of fluoroquinolone resistance . Conclusion Determining the prevalence of fluoroquinolone resistance in rectal flora has important implication s in the selection of targeted prophylactic antibiotic regimens . Antimicrobial profiles guided by rectal swabs may prove useful to optimize prophylaxis prior to TRUSBx ; this strategy is effective at reducing the rates of infectious complications , including sepsis , especially in men at higher risk of infectious complications PURPOSE Prostate biopsy related infectious complications are associated with significant morbidity . The risk of infectious complications in patients with prostate cancer on active surveillance remains under studied . MATERIAL S AND METHODS A total of 591 consecutive men who underwent prostate biopsy were prospect ively enrolled in a study evaluating prostate biopsy related complications between January 2011 and January 2012 . Of these men 403 were previously diagnosed with prostate cancer and were included in this study . They underwent a 14-core transrectal ultrasound guided prostate biopsy as part of an active surveillance regimen . A nurse contacted all men within 14 days of biopsy , and information was collected on potential complications , antibiotics received and bacterial culture results . RESULTS Fourteen patients ( 3.5 % ) had infectious complications including 13 requiring hospitalization . Five patients had positive urine cultures , and fluoroquinolone resistant isolates were identified in 4 patients , including 2 with extended spectrum beta-lactamase producing isolates . We evaluated the impact of risk factors including diabetes , benign prostatic hyperplasia and antibiotic regimen . However , only the number of previous prostate biopsies was significantly associated with an increased risk of infectious complications ( p = 0.041 ) . For every previous biopsy the odds of an infection increased 1.3 times ( OR 1.33 , 95 % CI 1.01 - 1.74 ) . CONCLUSIONS In men with prostate cancer on active surveillance the number of previous prostate biopsies is associated with a significant risk of infectious complications and every previous biopsy increases the risk of infectious complication . Fluoroquinolone resistant and extended spectrum beta-lactamase producing isolates represent the most commonly identified organisms . Men with prostate cancer on active surveillance should be informed of the risks associated with serial repeat prostate biopsies PURPOSE More than 1 million prostate biopsies are performed annually among Medicare beneficiaries . We determined the risk of serious complications requiring hospitalization . We hypothesized that with emerging multidrug resistant organisms there may be an increasing risk of infectious complications . MATERIAL S AND METHODS In a 5 % r and om sample of Medicare participants in SEER ( Surveillance , Epidemiology and End Results ) regions from 1991 to 2007 we compared 30-day hospitalization rates and ICD-9 primary diagnosis codes for admissions between 17,472 men who underwent prostate biopsy and a r and om sample of 134,977 controls . Multivariate logistic and Poisson regression were used to examine the risk and predictors of serious infectious and noninfectious complications with time . RESULTS The 30-day hospitalization rate was 6.9 % within 30 days of prostate biopsy , which was substantially higher than the 2.7 % in the control population . After adjusting for age , race , SEER region , year and comorbidities prostate biopsy was associated with a 2.65-fold ( 95 % CI 2.47 - 2.84 ) increased risk of hospitalization within 30 days compared to the control population ( p < 0.0001 ) . The risk of infectious complications requiring hospitalization after biopsy was significantly greater in more recent years ( p(trend ) = 0.001 ) . Among men undergoing biopsy , later year , nonwhite race and higher comorbidity scores were significantly associated with an increased risk of infectious complications . CONCLUSIONS The risk of hospitalization within 30 days of prostate biopsy was significantly higher than in a control population . Infectious complications after prostate biopsy have increased in recent years while the rate of serious noninfectious complications is relatively stable . Careful patient selection for prostate biopsy is essential to minimize the potential harms INTRODUCTION Prostate cancer is the most common form of cancer in Danish men , and the incidence is rising . The diag-nosis is made by transrectal prostate biopsy guided by ultrasound . This procedure has several complications , the most severe being sepsis . In our department , this is sought prevented by administering the prophylactic antibiotics metronidazol and ciprofloxacin . This study examined the rate of sepsis in patients who had the procedure performed at our department . METHODS The electronic patient records of all patients who had transrectal ultrasound of the prostate with biopsies performed at the Department of Urology at Naestved Hospital in the period from 1 May 2009 to 31 May 2011 were examined , and all admissions to our department ( or any department in the same region ) due to sepsis within two weeks of the procedure were registered . RESULTS A total of 438 patients had the procedure performed , some multiple times , which result ed in a total of 511 procedures . In all , four patients were later admitted due to sepsis , corresponding to 0.91 % . Three of the patients had positive blood and urine cultures in which Escherichia coli resistant to ciprofloxacin were found , the last had been prescribed antibiotics by a general practitioner the previous day , and no bacteria could be cultured . CONCLUSION The frequency of sepsis after transrectal needle biopsies from the prostate at our department was found to be below 1 % in this study , which is comparable to international findings . Most of the cases of sepsis were related to ciprofloxacin-resistant bacteria . Further r and omised studies are needed to investigate the ideal prophylactic regime . FUNDING not relevant . TRIAL REGISTRATION not relevant The objective of this study was to assess the value of a urine bacterial culture performed before prostate biopsy . We performed a prospect i ve study on 353 patients who underwent prostate biopsy . All patients had a urine bacterial culture performed before biopsy . We compared the outcomes of patients with bacteriuria ( left untreated ) with those of patients without bacteriuria . Of the 353 men , 12 had a pre-biopsy-positive bacterial culture and underwent prostate biopsy without any infectious complication . Fifteen patients with a negative pre-biopsy culture developed a post-biopsy-positive bacterial culture , but remained asymptomatic without any treatment . Only four men from the group without pre-biopsy bacteriuria developed an infectious complication , requiring 3 weeks of antibiotic therapy . The complication rates were similar for both groups . Our results suggest that routine urine bacterial culture before prostate biopsy is not useful when antibiotic prophylaxis and enema are performed . We do , however , suggest performing a urine bacterial culture before prostate biopsy for patients with a previous history of urinary tract infections Purpose Despite the recent innovations , complications of prostate biopsy can occur . The aim of this study was a prospect i ve monitoring of major septic complications occurring after transrectal prostate biopsy  , to describe their causing agents , to report the clinical course of these patients , and to give guidelines based on our personal experience . Methods This prospect i ve study was carried out between January 2009 and September 2010 . Complications were evaluated by telephone interviews . Results Between January 2009 and September 2010 , 447 ( 96.5 % ) completed the telephone interview .  Urosepsis occurred in ten patients ( 2.2 % ) and in three cases evolved into septic shock . Of these ten patients , nine had a positive blood culture , of whom eight for Escherichia coli and one for Aeromonas hydrophila , Aeromonas caviae , and Aeromonas sobria . In seven cases , the E. coli isolated were resistant to fluoroquinolone and six produced an extended spectrum beta-lactamase . Six E. coli were classified as multidrug-resistant organisms . Of the 10 patients , one died after the onset of multiorgan failure . For the other nine , the mean time spent in the hospital was 9 days ( range , 6–15 days ) . Conclusions Escherichia coli are developing new drug resistances . Early recognition of patients who harbor MDRO E. coli in their rectum or in the urine could be an important strategy for preventing sepsis . If a patient who has recently undergone transrectal prostate biopsy shows clinical signs of sepsis in the 48 h , a multiresistant E. coli infection must be suspected . The patient must be admitted urgently to the hospital , and carbapenem antibiotic therapy should be started PURPOSE To compare the incidence of infection between a 1 day and a 3 day antibiotic prophylaxis regimen for transrectal ultrasound ( TRUS ) guided prostate biopsy in a prospect i ve , r and omized open-label trial . MATERIAL S AND METHODS TRUS examination was performed in the left lateral decubitus position using a Brüel and Kjaer 7 MHz rectal probe . Biopsies were carried out with an 18 gauge Tru-cut needle fired by the h and -held Biopsy gun . An average of eight core biopsies ( range 6 to 12 ) was taken . From May 15 , 2000 to May 16 , 2001 , 363 patients were enrolled in this study . Patients were r and omized to receive either 1 day or 3 days of fluroquinolone antibiotic prophylaxis , consisting of either ciprofloxacin or levofloxacin orally . Antibiotics were begun at least 1 hour prior to biopsy . Seven days later , telephone follow-up was obtained . RESULTS Two ( 0.55 % ) of the 363 patients , one in each group , had an episode of sepsis . No urinary tract infection was reported . Traumatic complications were only minor and no significant difference was observed between both groups : hematospermia ( p > 0.4 ) , hematuria ( p>0.1 ) and rectorragia ( p>0.2 ) being reported most frequently . CONCLUSION There is no clinical ly nor statistically significant difference between a 1 day and 3 day antibiotic prophylaxis regimen for patients undergoing TRUS guided biopsies OBJECTIVES To assess the efficacy of tosufloxacin as a prophylactic agent for transrectal biopsy of the prostate ( TBP ) , we conducted a r and omized prospect i ve study comparing tosufloxacin versus levofloxacin . METHODS A r and omized prospect i ve study comparing tosufloxacin versus levofloxacin was performed . In group A , 124 patients received 300 mg tosufloxacin tosilate ( including 204 mg tosufloxacin ) twice daily for 2 days , with the initial dose being 2 h prior to biopsy . In group B , 119 patients received 200 mg levofloxacin in the same manner . RESULTS Infectious complications were reported equally in six cases in each group ( 4.8 % in group A and 5.0 % in group B ) . Each group included five cases of acute prostatitis and one of cystitis . Six patients suffering from prostatitis required hospitalization , while those with symptomatic urinary tract infection were treated as out patients . CONCLUSIONS Tosufloxacin was as effective as levofloxacin when administered twice daily for 2 days as prophylaxis for TBP , which suggests that this regimen is useful for reducing the clinical and febrile infection rate following TBP OBJECTIVES To assess the level of infectious complications and the impact of timing of a single , prophylactic , oral dose of ciprofloxacin 750 mg given either 2 hours before or in conjunction with ultrasound-guided core biopsy of the prostate in men without recognised risk factors and to analyse potential risk factors . METHODS All men undergoing prostate biopsy for elevated prostate specific antigen or clinical suspected prostate cancer were enrolled in an open , comparative prospect i ve study . Excluded were men with recognised risk factors for infective complications . Two end points were chosen : febrile genitourinary infection and the results of postbiopsy urine culture . RESULTS A total of 1322 prostate biopsy occasions were made in 1157 men . Twelve ( 0.9 % ) cases of febrile genitourinary infections were recorded , two of which had proven sepsis . Administrating the drug 2 hours before or at the time of biopsy ( p > 0.5 ) showed no statistical difference . Eight of 12 patients were shown to have prebiopsy undisclosed risk factors . Four percent developed postbiopsy , asymptomatic , significant bacteriuria . In addition , three ( 27 % ) men with prebiopsy unrecognised bacteriuria , who were accidentally enrolled , developed febrile genitourinary infection ; one had proven sepsis . CONCLUSIONS A single high-dose of oral ciprofloxacin 750 mg can be administered in direct conjunction with prostate biopsy to men without recognised risk factors , keeping the infection rate at approximately 1 % . Bacteriuria before biopsy is a major risk factor for infective complications . Attention given to recognising individual risk factors would reduce the risk of infection further Objectives To determine the effect of antibiotic prophylaxis on infective complications after transrectal needle biopsy of the prostate OBJECTIVE To determine the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae ( PE ) fecal carriage in patients that undergo transrectal ultrasonography-guided biopsy ( TRUSbx )  and its relationship with post-biopsy infections . METHODS A prospect i ve clinical study in 4 different tertiary hospitals between 2008 and 2010 was conducted . Four hundred men with sterile urine who were to undergo a TRUSbx because of the suspicion of prostate cancer were included and followed for 14 days after biopsy .  Rectal swab culture specimens were acquired immediately before the procedure . Demographic data , prophylaxis choice ,  quinolone or any  other antibiotic consumption within the past 2 months , history of prostatitis , repeat biopsy , intensive care unit admission , hospitalization , urethral catheterization , diabetes mellitus ( DM ) , and steroid usage were recorded . RESULTS ESBL carriage was detected in 19 % of patients and quinolone use within the last 2 months ; other antibiotic use within the last 2 months and DM were found to be significantly associated ( P < .05 ) . Symptomatic urinary tract infection ( UTI ) on the third day after biopsy was seen in 9 % of patients and was associated with fluoroquinolone ( FQ ) consumption before biopsy . Although ESBL-PE carriage was associated with post-biopsy UTI symptoms , it was not found to be associated with post-biopsy symptomatic UTI . Urosepsis was seen in 2 patients ( 0.5 % ) after biopsy , and both the patients were ESBL-PE carriers . CONCLUSION The presence of ESBL-PE was associated with DM and FQ consumption before biopsy . ESBL-PE carriage was associated with a high rate of post-biopsy UTI symptoms requiring further elucidation ; however , it was not associated with microbiologically proven infections . FQ consumption before TRUSbx was also associated with post-biopsy infections OBJECTIVES To determine whether antimicrobial prophylaxis could prevent infections after transrectal needle biopsy of the prostate using automated biopsy devices . METHODS We conducted a prospect i ve , r and omized , double-blind , multicenter trial in which a total of 537 patients received either oral ciprofloxacin 500 mg or placebo before transrectal needle biopsy of the prostate . Repeated urine cultures and urinalysis were obtained at 2 to 6 days after biopsy and 9 to 15 days after biopsy . The primary determinant of efficacy was bacteriologic response ( bacteriuria [ more than 10(4 ) colony-forming units (CFU)/mL ] versus no bacteriuria ) at the 9- to 15-day follow-up evaluation . RESULTS Two hundred twenty-seven ( 84 % ) of 269 ciprofloxacin patients and 230 ( 86 % ) of 268 placebo patients were valid for efficacy analysis in which a mean of four biopsies was performed . Six ciprofloxacin-treated ( 3 % ) and 19 placebo-treated ( 8 % ) patients had bacteriuria ( more than 10(4 ) CFU/mL ) after the procedure ( P = 0.009 ) . Six ciprofloxacin recipients ( 3 % ) and 12 placebo recipients ( 5 % ) had clinical signs and symptoms of a urinary tract infection ( UTI ) ( P = 0.15 ) . In addition , no ciprofloxacin-treated patients compared with 4 placebo-treated patients ( 2 % ) were admitted to the hospital for febrile UTI after the procedure . Ciprofloxacin reduced the expected net costs of treating infectious complications after biopsy by $ 23 per patient for an overall annual savings of $ 68,195 in the five study groups when compared with placebo . CONCLUSIONS Single-dose oral ciprofloxacin reduced bacteriuria after biopsy compared with placebo in patients undergoing transrectal prostatic biopsy and provided an economic advantage . In addition , this study establishes the actual rate of bacteriuria after transrectal needle biopsy of the prostate without antibiotic prophylaxis to be 8 % with a clinical rate of UTI of 5 % and a hospitalization rate of 2 % Although the estimate of the incidence of sepsis following  transrectal ultrasound-guided prostate biopsy ( TRUSPB ) is low , fluoroquinolone-resistant infections after prostate biopsy are being increasingly noted . This study was aim ed at determining the prevalence of faecal carriage of fluoroquinolone-resistant Escherichia coli strains before TRUSPB and at evaluating potential predisposing risk factors . The incidence of sepsis after prostate biopsy was determined , and our routine practice for antibiotic prophylaxis for TRUSPB was evaluated . A prospect i ve study was conducted in 342 consecutive patients undergoing prostate biopsy between December 2009 and July 2010 . Before TRUSPB , a rectal swab was cultured . The correlation between the presence of fluoroquinolone-resistant strains and plausible risk factors was investigated by the use of a question naire . Of the 236 patients included , 22.0 % ( 52/236 ) harboured ciprofloxacin-resistant E. coli strains . The use of fluoroquinolones in the 6 months before biopsy was associated with an increased risk of faecal carriage of fluoroquinolone-resistant E. coli strains ( p < 0.01 ) . Faecal carriage of fluoroquinolone-resistant E. coli strains was an important risk factor for infectious complications after TRUSPB ( p < 0.01 ) . In conclusion , a significant number of patients have faecal carriage of fluoroquinolone-resistant E. coli strains ( 22.0 % ) before TRUSPB . The use of fluoroquinolones in the previous 6 months before biopsy is a risk factor for faecal carriage of fluoroquinolone-resistant E. coli strains and for infectious complications after TRUSPB . Hence , the universal administration of fluoroquinolones should be reconsidered OBJECTIVES To evaluate the incidence , and clinical and bacterial features of iatrogenic prostatitis within 1 month after  transrectal ultrasound-guided biopsy  for detection of prostate cancer . METHODS From January 2006 to December 2009 , 3000 patients underwent a 21-core transrectal ultrasound-guided prostate biopsy at Henri Mondor Hospital ( Créteil , France ) and were prospect ively followed . All patients had a fluoroquinolone antimicrobial prophylaxis for 7 days . The primary study end-point was to evaluate the incidence of iatrogenic acute prostatitis within 1 month after the biopsy . The secondary end-point was to analyze the clinical and the bacterial features of the prostatitis . RESULTS Overall , 20 patients of the entire study population ( 0.67 % ) had an acute bacterial prostatitis within 2.90 ± 1.77 days ( range 1 - 7 days ) after the transrectal ultrasound-guided biopsy . The groups of patients with ( n = 20 ) and without ( n = 2980 ) infection were similar in terms of age , prostate-specific antigen level and prostate volume . Escherichia coli was the only isolated bacteria . The subsequent tests for antibiotic susceptibility showed a 95 % resistance for fluroquinolone and amoxicillin . Resistance to amoxiclav , trimethoprim-sulfamethoxazole , third generation cephalosporin and amikacin was 70 % , 70 % , 25 % and 5 % respectively . No resistance to imipenem was reported . They were all admitted for treatment without the need of intensive care unit referral . Complete recovery was achieved after 21.4 ± 7 days of antibiotic treatment . CONCLUSIONS A fluroquinolone-based regimen still represents an appropriate prophylaxis protocol to minimize the risk of acute prostatitis secondary to prostate biopsy . Patients should be provided the appropriate care soon after the onset of the symptoms . An intravenous third generation cephalosporin or imipenem-based therapy seem to provide satisfying results OBJECTIVES To prospect ively evaluate the efficacy of single dose antibiotic prophylaxis in 12-core transrectal ultrasonography ( TRUS ) guided prostate biopsy . METHODS A total of 400 patients who underwent prostate biopsy with TRUS guidance were included . The patients were prospect ively r and omized in three groups regarding antibiotic prophylaxis . The first group ( 139 patients ) received a single gram of intramuscular ceftriaxone , while the second group ( 131 patients ) had a 3-day course of oral ciprofloxacin . The third group ( 130 patients ) had single oral 500 mg of ciprofloxacin . All patients had urine cultures prior to biopsy and on the second day after biopsy . RESULTS The study groups were compared in terms of the results of urine cultures and clinical parameters . Overall , only seven patients ( 1.8 % of the cases ) had positive urine cultures with no difference between these three groups . Additionally , no significant difference was observed regarding morbidity rates in all groups . Only eight patients ( 2 % ) developed major complications requiring hospitalization . There was no increase in the rate of infectious complications when the biopsy core numbers were increased up to 12 . CONCLUSIONS The current study suggests that a single oral dose of antimicrobial prophylaxis is reasonable in TRUS prostate biopsy even in the case of 12-core sampling
target: Widespread use of fluoroquinolone prophylaxis may be associated with an increase in resistant Escherichia coli strains , posing a potentially major health issue in the future .
background: INTRODUCTION Transrectal ultrasound-guided biopsies ( TRUS-gb ) are associated with both mild and serious complications .
  Prophylactic antibiotics reduce the risk of septicaemia and mortality ; however , no international consensus exists on the timing and duration of antibiotics , including the optimal drug strategy .
  We review ed the current evidence supporting use of prophylactic antibiotics and the risk of complications following prostate biopsies .