Fosfomycin prophylaxis for transrectal prostate biopsy reduces infectious complications: A systematic review and meta-analysis

Abstract

Background: Infectious complications after transrectal ultrasound guided prostate biopsy (TRUSPB) have increased worldwide,most commonly due to antimicrobial resistance to fluoroquinolones, the most commonly used prophylactic agent. Fosfoymcin trometamol (FT) has broad spectrum antimicrobial coverage with adequate prostatic penetration and oral administration. We sought to appraise available evidence comparing FT to quinolones in preventing TRUSPB-related infectious complications. Methods: This review was registered in the PROSPERO database (registration number CRD42017057632). Electronic databases (Cochrane Library, EMBASE and Web of Science) were searched for studies comparing FT to fluoroquinolone-based prophylaxis. Studies were assessed for comparable outcomes and methodological quality (ROBINS-I). The primary outcome measure was the relative odds of overall infectious complications following TRUSPB, which was evaluated with meta-analysis. Safety and tolerability were also assessed. The relative odds of infection severity (Grade 1: bacteriuria, afebrile UTI; Grade 2: bacteraemia, febrile UTI; Grade 3: urosepsis) was also assessed. Results: Five studies, being three prospective randomised trials and two retrospective studies, representing 3112 patients, were included. FT significantly reduced overall infectious complications (OR 0.25, 95% CI 0.11 - 0.58). FT therapy conveyed incremental benefit for higher infectious complication grades [grade 2 (OR 0.11, 95% CI 0.04 - 0.28), and grade 3 (OR 0.17, 95% CI 0.09 - 0.32)]. Reduced complications due to fluoroquinolone-resistant and extended spectrum beta-lactamase (ESBL) producing organisms was also observed. Conclusions: FT is more effective as TRUSPB prophylaxis in comparison to fluoroquinolones, present through various analyses and antimicrobial resistance considerations. Future clinical trials should assess the performance of FT in other geographic locations or in comparison to targeted prophylaxis based on risk assessment or rectal cultures.L617436381 <br />