Infectious complications following transperineal prostate biopsy with or without periprocedural antibiotic prophylaxis-a systematic review including meta-analysis of all comparative studies.

Summary

Across 23 comparative studies (including two RCTs; n≈12,324), omitting periprocedural antibiotic prophylaxis for transperineal prostate biopsy did not increase genitourinary infections, fever, sepsis (0.16% vs 0.13%), or readmissions. Findings support antibiotic stewardship without compromising patient safety.

Key Findings

• No significant differences in GUI, fever, sepsis, or readmission between TPB with vs without prophylaxis (all p>0.25).
• Pooled sepsis incidence was very low and similar (0.16% with PAP vs 0.13% without).
• Subgroup and sensitivity analyses confirmed robustness; 30-day mortality was not observed.

Clinical Implications

Routine antibiotic prophylaxis for transperineal prostate biopsy can be safely omitted in most patients, aligning with stewardship goals; protocols should still consider high-risk individuals based on local epidemiology.

Limitations

• Heterogeneous study designs and incomplete endpoint reporting across studies
• Very low event rates limit precision for rare outcomes

Future Directions

Define criteria for selective prophylaxis in specific high-risk subgroups and evaluate cost-effectiveness and resistance impact of de-implementation.