Efficacy of a Single- Dose Fosfomycin as Antibiotic Prophylaxis Prior to Transrectal Ultrasound-Guided Prostate Biopsy

Abstract

Objectives: The goal to prevent increasing antibiotic resistance in urologic procedures has a significant impact on the choice of preoperative antibiotic prophylaxis. The efficacy of an old-new antibioticfosfomycin in TRUS-guided prostate biopsy was also evaluated.

Methods: Included were patients who underwent TRUS-guided prostate biopsy from August 1, 2015- July 31, 2016. Patients who satisfied the inclusion criteria were included. Patients were asked to take a single dose of 3g oral fosfomycin 1-3 hours prior to the procedure. Urinalysis was taken pre biopsy and post biopsy (at least 7-10 days). Occurrence of afebrile and febrile UTI were noted. Patients were informed of the signs and symptoms that need to be reported to the investigators.

Results: There were 74 patients enrolled in the study. The mean average age of patients was 66.5(±7). Majority of patients were having moderate lower urinary tract symptoms (40.5%) followed by patients with indwelling foley catheter (31.1%). Seventeen percent of patients had concomitant diseases like diabetes mellitus, cystolithiasis, nephrolithiasis, hypertension, etc. Pre biopsy, 51.4% of patients had asymptomatic urinary tract infection and 35% of these patients showed resolution of UTI post biopsy. The incidence of febrile UTI was 4%, 3.8% of patients with UTI pre biopsy and 50% of patients without UTI pre biopsy. Finally, the presence of afebrile and febrile UTI pre and post biopsy was statistically significant at 5% level of significance.

Conclusion: Single dose oral fosfomycin as prophylactic antibiotic in TRUS- guided prostate biopsy can be an alternative to reduce the rate of fluoroquinolone- resistant infections.