Reducing infectious complications and healthcare costs in transrectal ultrasound-guided prostate biopsy with single-dose cefmetazole and levofloxacin

Abstract

Introduction

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 cefmetazole (CMZ) is effective against these resistant E. coli strains, there are only a few reports on its use in TRUS-PBx. We investigated the efficacy of antimicrobial prophylaxis (AP) for TRUS-PBx using intravenous CMZ and oral levofloxacin (LVFX).

Methods

This single-center retrospective observational before-and-after study was conducted between January 2014 and December 2023 at Komaki City Hospital, Japan. The incidence of febrile urinary tract infection (UTI), urosepsis, bacteremia, readmission, abscess, and healthcare-related costs after TRUS-PBx were compared between individuals who received a single dose of intravenous cefazolin (CEZ) and oral LVFX and those who received single doses of intravenous CMZ and oral LVFX. 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 readmission (3 cases) were observed only in the CEZ+LVFX group. Multivariable analysis indicated that the use of CMZ+LVFX significantly decreased febrile UTI after TRUS-PBx (odds ratio: 0.20, 95% confidence interval: 0.04–0.98, P = 0.047). 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.