Prevention of Urinary Tract Infection and Sepsis Following Transrectal Prostatic Biopsy

Abstract

Transrectal biopsy is one of the more popular methods for the diagnosis of prostatic cancer. However, there is disagreement as to whether the use of prophylactic antimicrobials decreases the incidence of fever and urinary tract infections, which may follow this procedure. A prospective randomized double-blind study involving 63 patients was instituted to determine the efficacy of carbenicillin indanyl sodium in reducing these complications. The protocol consisted of administration of 2 tablets 4 times daily of a placebo or the treatment drug 24 h before and after biopsy. Clean catch urine cultures were obtained 24 h before biopsy and at 48 h and 2 wk after the procedure. Blood cultures were performed 15 min after biopsy. Clinical parameters were also monitored closely in the hospital for 48 h after biopsy. A total of 48 patients was considered evaluable. Of 23 patients who received the study drug 2 (8.6%) had positive urine cultures at 48 h compared to 9 of 25 (36%) from the placebo group. A similar result was observed from the 2 wk culture data, in which 2 of 23 patients (8.6%) in the treatment group had positive urine cultures as opposed to 5 of 25 (20%) receiving the placebo. Fever occurred in 48% of the placebo and in 17% of the carbenicillin groups. Thus, prophylactic administration of carbenicillin indanyl sodium evidently decreases the complications of fever and urinary tract infections following transrectal biopsy of the prostate.