Significance of Targeted Antimicrobial Prophylaxis Using Rectal-culture Selective Screening Media Prior to Transrectal Prostate Biopsy: A Multicenter, Randomized Controlled Trial

OBJECTIVE To examine whether antimicrobial prophylaxis based on screening rectal cultures using selective media prevented acute bacterial prostatitis following transrectal prostate biopsy (TRPB). METHODS In this multicenter, randomized controlled trial, we enrolled 403 patients undergoing TRPB with low risks of infectious complications. Patients were randomized into a cultured group (CG) or no cultured group (NCG). In the CG, patients with positive-culture results for fluoroquinolone (FQ)-resistant or extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) used piperacillin/tazobactam as prophylaxis, and those with negative-culture results and in the NCG used levofloxacin. The primary endpoint was the incidence of acute prostatitis after TRPB. The secondary endpoint was the accuracy of the selective media. RESULTS Of 373 patients (CG, 187; NCG, 186), 67 were positive, and 120 were negative for rectal culture in the CG. The overall incidence of prostatitis after TRPB was 1.1% (n = 4). The incidences in the CG and the NCG were 1.6% (n = 3, all negative-culture cases) and 0.5% (n = 1), respectively, without significant difference (P = .3). No prostatitis occurred in the positive-culture group. The sensitivity and specificity of the levofloxacin-insusceptible selective media were 98.1% and 94.7%, respectively. CONCLUSION Screening with selective media before TRPB in patients with low infectious risks may provide additive value to preventing post-biopsy prostatitis. Piperacillin/tazobactam can be considered when FQ-resistant or ESBL-producing E. coli is detected. UROLOGY 196: 32-39, 2025. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.