Isepamicin alone as antimicrobial prophylaxis for transrectal prostate needle biopsy: “Do we still need levofloxacin? ”

Abstract

The purpose of this study was to investigate whether conventional levofloxacin (LVFX) administration is unnecessary for transrectal ultrasound-guided prostate needle biopsy (TRP-Bx) in view of the increase in LVFX-resistant Escherichia coli and appropriate use of antibiotics. The study included 636 cases undergoing TRP-Bx, divided into two groups based on the prophylactic antibiotic regimen. Group 1 (n = 308) received both oral levofloxacin (LVFX) 500 mg and intravenous isepamicin (ISP) 400 mg. Group 2 (n = 328) received only intravenous ISP 400 mg. Biopsies involved sampling 12 cores using an 18G needle. A high-risk subgroup included patients with a large prostate (>75 ml), severe dysuria, diabetes mellitus, or steroid use. Significantly more high-risk cases were in Group 2 than in Group 1 (35.7 % vs. 24.4 %, p = 0.003). Febrile genitourinary tract infections (fGUTIs) occurred in three patients (0.5 %), with no significant difference between the groups (0.3 % in Group 1 vs. 0.6 % in Group 2). No fGUTI complications were noted among high-risk cases in either group. Of the fGUTI cases, one involved LVFX-resistant E. coli; another involved E. coli susceptible to both LVFX and amikacin, isolated from blood. The single- and short-duration intravenous dose of ISP 400 mg would appear to be one of possible options in preventing TRP-Bx-related fGUTIs in both low-risk and high-risk patients.