Role of rectal swab cultures on infectious complications following transrectal prostate biopsy

Introduction: To study the impact of rectal swab culture based targeted antimicrobial prophylaxis on infectious complications in patients undergoing transrectal ultrasound guided prostate biopsy. Methods: A prospective observational study was conducted in a tertiary care hospital at Kolkata, we compared the incidence of infectious complications in men who received rectal swab cultured based targeted prophylaxis versus empirical antibiotics prophylaxis who underwent transrectal ultrasound guided prostate biopsy. The targeted prophylactic antibiotics were selected from rectal culture swab plated on selected media containing ciprofloxacin to identify fluoroquinolone resistance, patients with infectious complications within 30 days of prostate biopsy were taken into consideration. Results: Twenty-four out of the 50 patients (48%) harbored FQ resistant organisms. Only three patients (6%) in the targeted prophylaxis group had infectious complications of UTI and Low-grade fever. In contrast, 6 (12%) of the 50 men undergoing the procedure without culture had infectious complications, two of these (4%) had sepsis. Conclusion: Frequently used fluoroquinolone prophylaxis fails to give adequate cover because of high rate of fluoroquinolone resistance of the rectal organism. Rectal swab derived antibiotics prophylaxis can reduce post biopsy infectious complications significantly.