Fosfomycin, trimethoprim/sulfamethoxazole, or ciprofloxacin: which is better for infection prophylaxis with transrectal prostatic biopsy? Multicenter study

Abstract Background Antibiotic prophylaxis is necessary to avoid infectious complications following transrectal ultrasound-guided prostate biopsy (TRUSPB). Till now, there is no consensus or international agreement for the optimal type of antibiotics, particularly after the recommendation against using fluoroquinolones as antibiotic prophylaxis due to their toxicity profile and the increasing bacterial resistance to them. Aim of the work This study aimed to retrospectively compare the efficacy of ciprofloxacin, trimethoprim/sulfamethoxazole, or fosfomycin as perioperative prophylaxis in patients undergoing TRUSBP. Patients and methods We retrospectively analyzed 502 patients who underwent TRUSPB in 2 urological facilities in Egypt and Germany between June 2020 and July 2023 and received either ciprofloxacin (n: 121), trimethoprim/sulfamethoxazole (n: 109), or fosfomycin (n: 272) as antibiotic prophylaxis. Infection rate and site and sepsis rates were assessed within 1 month after the procedure. The causative organism, management protocol, and antibiotics used in management were also studied. Results Infections developed among 3.3% of patients who received fosfomycin, 2.8% who received trimethoprim/sulfamethoxazole, and 0.8% who received ciprofloxacin. The results showed no statistically significant difference among the 3 arms. In Egypt and Germany E. coli was the most common causative Organism. Although there were different management strategies between Egypt and Germany, there was no fatal complication or intensive care admission in the three groups. Conclusions Fosfomycin, ciprofloxacin, and trimethoprim/sulfamethoxazole effectively prevent post-transrectal prostate biopsy infections. Further research is needed to evaluate the efficacy and safety of different types of antibiotics in different populations in which regional variations in pathogen prevalence and resistance patterns should be considered.