Antibiotics prophylaxis before prostate biopsy in practice: Review of online clinical guidelines

Sir, The inaugural American Urologic Association (AUA) Quality Improvement Summit on January 25, 2014 introduced the directive to compile a white paper on the incidence, prevention, and treatment of complications related to prostate needle biopsy. We believe this summit brings to the urologic community’s attention the critical fact that published guidelines in antibiotic prophylaxis do not reflect the escalating danger of post prostate needle biopsy infections. The known infectious complication rates range from 0.1% to 7%, depending on the antimicrobial agent used.[1] Even with prophylactic antibiotics, 5% of men will develop asymptomatic bacteriuria and 2–3% will develop symptomatic urinary tract infection.[2] The current AUA best practice policy statement on urologic surgery antimicrobial prophylaxis, last updated in February 2012, recommends fluoroquinolones or 1st through 3rd generation cephalosporins as the prophylactic antimicrobial agents of choice preceding prostate needle biopsy. This recommendation does not account for the fact that the overall risk of post-biopsy infections has risen over the past decade.[2-4] It also does not account for the increasing rate of quinolone resistance, as evidenced by the dramatic 22% of men found to have quinolone-resistant flora on prebiopsy rectal swab.[1] While the origin of this change in microbial sensitivity is likely complex and multifactorial, possibly related to increased, inappropriate, or repeated utilization of antibiotics, the fact remains that our guidelines for prophylaxis need to reflect these factors in order to effectively protect patients receiving prostate needle biopsies.