The effect of different antibiotic use on infection parameters and other complications in transrectal ultrasonography-guided prostate biopsy prophylaxis

Prostate cancer is the second most common tumor in the male population and the most common cancer of the urogenital system. Especially in recent years, with the increasing use of screening methods, the frequency of diagnosis has increased, and deaths due to cancer have decreased thanks to early diagnosis. As the importance of early diagnosis of cancer is increasing, the increasing number of prostate biopsies is resulting in early detection of prostate cancer. The increasing number of biopsies actually leads to frequent occurrence of post-biopsy infections, which are actually a low-probability complication, and has the potential to burden our healthcare system. The aim of this study is to retrospectively investigate the relationship between patients' complaints, antibiotic regimens they use, infectious parameters used in examinations and screenings, and the development of infection, in order to identify possible risk factors and help prevent post-prostate biopsy infections. Patients who underwent transrectal prostate biopsy at our hospital were retrospectively screened. Follow-up and treatment plans were implemented, and 297 patients who did not discontinue follow-up after biopsy were included in the study. Patients were evaluated in terms of various parameters, especially infectious ones. The average age of the patients was 65 and the median PSA value was found to be 6.9 ng/ml. While there was no difference in the antibiotics used between patients who developed infections and those who did not, infectious parameters were significantly higher in the group that developed infections. Especially CRP and PCT showed significant diagnostic value in distinguishing between the two groups, with threshold values of 24 mg/L for CRP and 0.7 µg/L for PCT indicating a diagnosis of infection. Although there was a significant increase in infectious parameters in the group using fosfomycin compared to other antibiotics, this difference did not statistically show significant difference between the two groups. Although this information suggests fosfomycin as a usable agent in biopsy prophylaxis during the era of quinolone resistance, the quinolone group still maintains its value in treatment and prophylaxis. Identifying population-specific risk factors for preventing post-biopsy infections is of particular importance, and in our cohort,factors such as prostate size and antibiotic exposure in the last 6 months were found to be important independent risk factors. Although quinolone resistance was not detected positive in any of our patients who developed infections in rectal swab culture, its use was concluded to provide clinical contribution due to its ability to provide additional information in case of possible infection and illuminate treatment. Minimizing contamination with rectal flora by using the transperineal route for biopsy to prevent post-biopsy infections is also a logical method. We believe that comparing quinolone and fosfomycin groups with larger patient series will lead to more reliable results in transrectal prostate biopsy prophylaxis, which is still widely used worldwide.