This is a single centre retrospective study to examine the effect of rectal swab culture-directed prophylaxis on the incidence of prostate biopsy associated infections. Secondary objectives were to determine the rate of fluoroquinolone resistance and extended-spectrum beta-lactamase production in local rectal flora. Of a total of 487 patients, 314 received pre procedure rectal cultures and 173 did not. No difference is seen between the groups in age, Charlson co-morbidity index, mean prostate specific antigen (PSA) or ethnicity. However 65% of rectal swab guided antibiotic group received supplemental gentamicin while only 32% of the empiric group received it which was statistically significant (p<0.001). They had fewer infectious complications (1.9% vs. 2.9%; P=0.5). The incidence of fluoroquinolone resistance and extended-spectrum beta-lactamase production was 12.1% and 0.64%, respectively. The authors recognise the limitations of the study, i.e. retrospective, underpowered, non-availability of medical records for few patients. Given their results they have calculated that the number of patients needed for a properly powered, prospective randomised controlled trial would be at least 784. With a growing body of evidence the authors feel that this could potentially be the way forward in changing the pattern of post TRUS biopsy infections.