Comparison of Urinary Tract Infection Rates Between Transperineal Prostate Biopsies with and Without Prophylactic Antibiotics: An Updated Systematic Review and Meta-Analysis

Abstract

Background and Objectives: The European Association of Urology (EAU) Guidelines on Prostate Cancer note emerging evidence suggesting that antibiotic prophylaxis may not be necessary for transperineal prostate biopsies. However, formal recommendations are pending further research. This meta-analysis compares urinary tract infection (UTI) rates following transperineal prostate biopsies with and without antibiotic prophylaxis. Materials and Methods: We searched PubMed, EMBASE, and the Cochrane Library for relevant studies published up until June 2024. The inclusion criteria were as follows: (a) patients undergoing transperineal prostate biopsy; (b) comparisons between groups with and without antibiotic prophylaxis; and (c) outcomes including UTI and sepsis rates. Exclusion criteria were studies lacking a full text or appropriate control groups and duplicates. Quality assessment was conducted using the Scottish Intercollegiate Guidelines Network checklist. Results: Nine studies (two RCTs and seven non-RCTs) met the inclusion criteria. Analysis revealed no significant difference in UTI rates between groups with and without prophylaxis (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 0.50–2.31, I2 = 0%, p = 0.86). Similarly, sepsis rates did not differ significantly (OR: 1.35, 95% CI: 0.36–5.12, I2 = 0%, p = 0.66). Conclusions: Our meta-analysis found no significant differences in UTI and sepsis rates between transperineal prostate biopsies performed with or without antibiotic prophylaxis. However, patients at high risk for UTIs may still benefit from antibiotic prophylaxis. Larger, prospective randomized trials are necessary for more conclusive evidence.