Reducing Infectious Complications and Healthcare Costs in Transrectal Ultrasound-Guided Prostate Biopsy with Single-Dose Cefmetazole and Levofloxacin

AIM: To investigate the efficacy of antimicrobial prophylaxis (AP) for TRUS-PBx using intravenous cefmetazole (CMZ) and oral levofloxacin (LVFX). BACKGROUND: Fluoroquinolones (FQ) are currently the first choice as prophylactics for transrectal ultrasound-guided prostate biopsy (TRUS-PBx). However, infections caused by FQ-resistant or extended-spectrum β-lactamase producing Escherichia coli remain a significant concern. Although CMZ is effective against these resistant E. coli, there are only a few reports on its use in TRUS-PBx. METHODS: This single-center retrospective observational study was conducted between January 2014 and December 2023 at Komaki City Hospital, Japan. The incidence of febrile urinary tract infection (UTI), urosepsis, bacteremia, re-admission, abscess, and healthcare-related costs after TRUS-PBx were compared between those who received a single dose of intravenous cefazolin (CEZ) and oral LVFX and single doses of intravenous CMZ and oral LVFX, from January 2014 to December 2023. The risk factors for post-TRUS-PBx febrile UTI were analyzed using multivariable logistic analysis. RESULTS: The incidence of febrile UTI after TRUS-PBx was 0.77% (9/1,168) in the CEZ + LVFX group and 0.20% (2/1,008) in the CMZ + LVFX group. Complications such as urosepsis (5 cases), bacteremia (3 cases), abscess (2 cases), and re-admission (3 cases) were observed only in the CEZ+LVFX group. The use of CMZ+LVFX as an AP significantly decreased febrile UTI after TRUS-PBx. CMZ+LVFX use reduced healthcare-related costs by JPY 975.5 (USD 6.8) per TRUS-PBx compared to CEZ+LVFX. CONCLUSIONS: Empirical AP with CMZ + LVFX before TRUS-PBx reduced the incidence of infectious complications and healthcare-related costs.