Efficacy and Safety of Two Fosfomycin Regimens as Antimicrobial Prophylaxis for Transrectal Prostate Biopsy: A Randomised Study.
PURPOSE
Prostate biopsy is the gold standard for prostate cancer diagnosis; unfortunately, this procedure is not free from complications. Recent studies have shown an increase in antibiotic resistance. The aim of our prospective randomized study was to evaluate the efficacy and safety of a prostate biopsy prophylaxis protocol using 2 vs. 3 fosfomycin doses.


METHODS
Two hundred and ninety-seven patients undergoing transrectal systematic ultrasound (US)-guided (n = 277) or transrectal fusion prostate biopsy (n = 20) were prospectively evaluated and randomized by date of birth, to receive 2 (even years, group A) versus 3 doses of fosfomycin (odd years, group B), and prospectively evaluated.


RESULTS
Two hundred and ninety-seven patients were randomized to group A (n = 162) or group B (n = 135). The 2 groups were comparable with respect to age, comorbidity, PSA value, prostate volume, operative time and urine culture results. Out of 297 patients, 44 (14.8%) developed complications after the procedure; 2.7% (8/297) of patients developed fever >38° requiring hospitalization (6 [3.7%] in group A and 2 [1.5%] in group B, p = 0.29). Patients who underwent fusion biopsy were more frequently readmitted in comparison with patients undergoing US-guided prostate biopsy (p = 0.000).


CONCLUSION
The low fever and prostatitis rate suggest that fosfomycin prophylaxis is safe and efficient. There is no significant difference in clinical outcome between the 2 dosage regimens.
["D'Elia|Carolina|C|", 'Mian|Christine|C|', 'Hanspeter|Esther|E|', 'Ladurner|Christian|C|', 'Palermo|Salvatore Mario|SM|', 'Pycha|Stefan|S|', 'Saleh|Omar|O|', 'Cai|Tommaso|T|', 'Spoladore|Greta|G|', 'Kafka|Mona|M|', 'Pycha|Armin|A|', 'Trenti|Emanuela|E|']
D000368:Aged D000900:Anti-Bacterial Agents D019072:Antibiotic Prophylaxis D001424:Bacterial Infections D002985:Clinical Protocols D005578:Fosfomycin D006801:Humans D061705:Image-Guided Biopsy D008297:Male D008875:Middle Aged D011183:Postoperative Complications D011446:Prospective Studies D011467:Prostate D011471:Prostatic Neoplasms D012007:Rectum D016896:Treatment Outcome
Fosfomycin Prophylaxis Prostate biopsy Urinary tract infection