Does intravenous cefuroxime improve the efficacy of ciprofloxacin for preventing infectious complications after transrectal prostate biopsy? A prospective comparative study

Objectives: To compare the frequency of infection after transrectal ultrasonography (TRUS)-guided biopsy of the prostate (TRUSBP) using prophylactic ciprofloxacin with or without adding cefuroxime.

Patients and methods: Between June 2008 and October 2009, 205 consecutive patients had TRUSBP with the use of oral 500 mg ciprofloxacin twice per day, 2 days before and 3 days after the biopsy (defined as group A). Starting from November 2009 and onwards, 250 consecutive patients had TRUSBP using the same previous protocol of antibiotic prophylaxis but with the addition of intravenous 1.5 g cefuroxime given 30 min before the procedure (defined as group B). The incidence of sepsis after TRUSBP, together with the results of urine and blood cultures and antibiotic sensitivity, were compared between the groups.

Results: Fever after TRUSBP was recorded in 18 of 205 patients in group A (8.8%) and in nine of 250 in group B (3.6%); the difference was significant (P = 0.018). Urine culture was positive in 14 and five of patients in groups A and B, respectively, with extended-spectrum b-lactamase-producing (ESBL) Escherichia coli as the most common organism. The blood culture was positive in seven and three patients in groups A and B, respectively, with ESBL E. coli as the most common organism. All patients who had sepsis after TRUSBP sepsis were treated successfully.

Conclusion: Adding a single intravenous injection with 1.5 g of cefuroxime to oral ciprofloxacin significantly reduced the frequency of infectious complications after TRUSBP.