Infectious complications in patients undergoing transrectal prostate-biopsy with ciprofloxacin compared to fosfomycin-trometamol

PURPOSE: To evaluate the risk of infectious complications associated with the use of ciprofloxacin (CIP) or fosfomycin-trometamol (FMT) for antibiotic prophylaxis in patients undergoing transrectal prostate biopsy (TrBx). METHODS: A retrospective, single-centre analysis was conducted, including patients who underwent TrBx from 2015 to 2023 and received CIP or FMT for antimicrobial prophylaxis. The primary endpoint was symptomatic urinary tract infections within 30 days after TrBx, and the secondary endpoint was hospitalization due to infectious complications. Logistic regression was used to assess the risk of infection, adjusted for variables such as age, prostate size and comorbidities. Hospitalization rates were compared using the chi-square test. RESULTS: Overall, 913 patients were eligible for inclusion, of whom 491 had received CIP and 422 had received FMT. Infectious complications occurred in 38/913 (4.2%) of all patients, 12/491 (2.4%) of whom had received CIP and 26/422 (6.2%) of whom had received FMT. Multivariable analysis revealed a significantly greater risk of infectious complications with FMT (adjusted odds ratio 2.99, 95% CI 1.39-7.16, p = 0.008) compared to CIP. Hospitalization rates were similar in the CIP group (8/12, 66.6%) and FMT group (14/26, 53.5%, p = 0.7), but one death occurred due to fulminant sepsis in the FMT group. CONCLUSION: Compared with CIP, FMT prophylaxis is associated with a greater risk of infectious complications and should be used cautiously in routine clinical practice. Given the uncertainty of FMT's efficacy in preventing infections after TrBx, alternative antibiotic regimens should be preferred, or transitioning to the transperineal biopsy approach may further reduce infection risk and support antibiotic stewardship.