Infection complications after transrectal ultrasound-guided prostate biopsy: A radiology department's experience and strategy for improvement

Introduction: Transrectal ultrasound (TRUS)-guided prostate biopsy is a common procedure performed to diagnose prostate cancer. The risk of infection complications is well-described in the literature, and strategies to avoid such complications continue to evolve over time. We performed a retrospective review of our infection com-plications and propose a strategy for improvement.Methods: We reviewed clinical outcomes from patients undergo-ing TRUS-guided prostate biopsy at our institution from November 2018 to November 2020. We reported the antimicrobial prophy-laxis received, whether the biopsy was systematic or targeted, and we examined the rate of clinically significant infection complica-tions and hospitalization.Results: Among 312 men who underwent TRUS-guided prostate biopsy during the study period, seven (2.2%) had an infection. Four patient groups with distinct antimicrobial regimen were identified; the largest of these patient groups received a three-day course of cefixime and a single dose of fosfomycin (59%). The proportion of patients with infection complications across these groups did not demonstrate a statistically significant difference (p=0.803). There was no significant difference in proportion of infection between systematic and targeted biopsy groups (3.0% vs. 0%, p=0.204). The proportion of patients hospitalized was 1.3%, with a mean length of stay of four days.Conclusions: We report a rate of clinically significant infection fol-lowing TRUS-guided prostate biopsy of 2.2%. Due to our referral pathway, we have an inconsistent approach to antimicrobial pro-phylaxis, although there was no statistically significant difference in infection rate between the groups. We propose a standardized approach that may lead to improved patient outcomes.