Lee, C., You, D., Jeong, I.G., Hong, J.H., Choo, M.S., Ahn, H., . . . Kim, C.S. (2015). Antibiotic prophylaxis with intravenous ceftriaxone and fluoroquinolone reduces infectious complications after transrectal ultrasound-guided prostatic biopsy. Korean Journal of Urology, 56, 466–472. 

To compare the effectiveness of standard fluoroquinolone prophylaxis with fluoroquinolone plus ceftriaxone in the prevention of infection post prostate biopsy

Patients received one of three prophylaxis regimens: (a) 500 mg fluoroquinolone by mouth twice a day for three days, (b) 500 mg fluoroquinolone by mouth twice a day for three days plus 2 g IV ceftriaxone once before biopsy, or (c) 500 mg fluoroquinolone by mouth twice a day for more than seven days plus 2 grams IV ceftriaxone once before biopsy.

• N = 5,577   
• MEAN AGE = 64 years
• AGE RANGE = 18–92 years
• MALES: 100%
• CURRENT TREATMENT: Immunotherapy
• KEY DISEASE CHARACTERISTICS: None described
• OTHER KEY SAMPLE CHARACTERISTICS: N/A

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: South Korea

• PHASE OF CARE: Diagnostic

• Retrospective case review

Infection post prostate biopsy was defined as any of the following: a temperature greater than 38 degrees Celsius, a white blood cell count greater than 12,000/mm³, a urinary tract infection, or acute prostatitis.

A significant decrease of infections was observed post prostate biopsy for patients that received prophylaxis with fluoroquinolone plus ceftriaxone (p < 0.001). One percent of patients who received fluoroquinolone prophylaxis had infectious complications compared to 0.3% of patients who received fluoroquinolone plus ceftriaxone. Patients who received fluoroquinolone prophylaxis for more than seven days had no added reduction of infection compared to patients who received fluoroquinolone prophylaxis for three days.

Infection prophylaxis with fluoroquinolone alone after prostate biopsy may be insufficient because of increasing resistance among pathogens, including Escherichia coli. The addition of 2 grams IV ceftriaxone before prostate biopsy was correlated with a significant reduction in infectious complications at one hospital in South Korea.

• Risk of bias (no random assignment)
• Unintended interventions or applicable interventions not described that would influence results
• Findings not generalizable
• The time frame of the retrospective comparison groups differed by several years (group 1: 2005–2009 versus groups 2 and 3: 2010–2012); thus, other clinical practice variations may have affected the results.
• Patient adherence to oral fluoroquinolone was not assessed.
• For infectious cases to be identified, patients with complications needed to return to the participating hospital. Patients with complications may have gone to other hospitals, affecting results.
• Groups were not assessed for risk factors, so comparison between groups is limited.
• The study was conducted at one hospital, limiting generalizability to other hospitals.
• Observation/reporting time frame for infectious complications after prostate biopsy not defined

Adequate patient education on potential infectious complications is necessary post prostate biopsies. To tailor infection prophylaxis, nurses should consider assessing for individual risk factors for infection (e.g., diabetes, history of organ transplant, etc.) and collect rectal swabs to identify quinolone-resistance organisms.