Incidence of Sepsis After Transrectal Ultrasound-Guided Prostate Biopsy in Dubai Tertiary Care Hospitals: A Multicenter Cohort Study

Background: Post-biopsy sepsis is a key safety concern after transrectal ultrasound-guided prostate biopsy (TRUS-Bx), yet data from the Middle East, where antimicrobial resistance patterns and prophylaxis practices may differ, remain limited. We assessed the incidence, timing, and risk factors for post-biopsy sepsis across three tertiary care hospitals in Dubai, United Arab Emirates. Methods: We conducted a retrospective cohort study across three tertiary care hospitals within a single private network (2010-2021; n = 139). The primary outcome was clinically recorded sepsis after TRUS-Bx; for sepsis cases, time to onset (days) was recorded. Prophylaxis regimens were coded and grouped as single-agent versus combination. Associations were summarized as odds ratios (ORs) with 95% confidence intervals (CIs) and tested using Fisher's exact tests. Continuous variables were presented as mean ± standard deviation (SD) and median (interquartile range (IQR)). Age was abstracted in categories; when a mean age was reported, category midpoints were used. Results: The cohort was multinational (39 nationalities), with the largest groups being British (28.8%), American (8.6%), and Emirati (6.5%). Sepsis occurred in 21/138 (15.2%), averaging 1.75 cases/year. Among sepsis cases, the median time to onset was two days (IQR: 1-4; mean: 3.9; range: 1-22). Prophylaxis was documented in 133/139 patients: single-agent (58, 43.6%) versus combination (75, 56.4%). Sepsis risk did not differ by regimen group (p = 0.320) or across individual regimens (p = 0.81). Current smoking was associated with higher odds of sepsis (OR: 4.03; 95% CI: 1.31-12.39; p = 0.023), while hypertension was associated with lower odds (OR: 0.19; 95% CI: 0.053-0.69; p = 0.007). Diabetes showed no association (OR: 1.06; p = 1.00), and hyperlipidemia showed a non-significant trend (OR: 0.23; p = 0.061). Prostate-specific antigen (PSA) (n = 133) had a median of 7.74 (IQR: 5.74-15.0) and a mean of 15.70 ± 22.02. Prostate volume (n = 122) had a median of 39 mL (IQR: 30-54.8) and a mean of 45.0 ± 20.5. Conclusion: In this multinational cohort from Dubai's private sector, post-TRUS-Bx sepsis occurred in 15.2% of cases and typically presented within the first few days. Combination prophylaxis did not reduce risk compared with single-agent regimens. Current smoking was associated with increased odds of sepsis, whereas hypertension was associated with lower odds.