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.

Rectal swab culture–directed antimicrobial prophylaxis for prostate biopsy and risk of post procedure infection: a cohort study.
Dai J, et al.
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Gokul Vignesh Kanda Swamy

ABM University Health Board, Swansea, UK.

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