Use versus nonuse of antimicrobial prophylaxis prior to transperineal prostate biopsy: a propensity score-matched analysis

Background: Transperineal prostate biopsy offers advantage over a transrectal approach by reducing the risk of infectious complications. However, the necessity for antimicrobial prophylaxis (AP) before a transperineal prostate biopsy is less clear. This study aimed to study the rate of infectious complications following transperineal prostate biopsy with or without AP. Materials and methods: Propensity score matching was done for 1,273 patients who underwent transperineal prostate biopsy between October 2020 and October 2024 to adjust for differences in covariates. Parameters including the rate of urinary tract infection (UTI) requiring or not requiring hospitalization between patients who received AP and those who did not receive AP were then compared. Results: A total of 288 patients were matched for each group and baseline characteristics were balanced between groups. The overall incidence of UTI was very low in both groups without significant difference. UTI requiring hospitalization occurred in only one patient in the AP group (0.1%) and none in the non-AP group. Nonhospitalized UTI occurred in 0.7% of the AP group and 0.3% of the non-AP group (P = 1.000). Conclusion: There was no significant difference in the rate of UTI based on the use or nonuse of AP prior to transperineal prostate biopsy. The overall incidence of UTI was very low regardless of the use of AP. Omission of AP prior to transperineal prostate biopsy might be possible, which would help promote antimicrobial stewardship.