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Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: fosfomycin trometamol, an attractive alternative



To compare fosfomycin trometamol (FT) and ciprofloxacin (CIP) for antibiotic prophylaxis in transrectal prostate biopsy (TR-PB).

Patients and methods

Data for 1109 patients (mean age 66.7 ± 8.45) who underwent TR-PB between March to September 2015 in seven Italian urological institutions were retrospectively reviewed, of which 632 received FT (Group 1) and 477 received CIP (Group 2) for prophylaxis. We reviewed all urine culture results obtained after the procedure, all adverse drug reactions (ADRs) related to the drug and all febrile and/or symptomatic urinary tract infections (UTIs) occurring within 1 month after TR-PB. The rate of symptomatic UTIs and the rate of ADRs were considered the main outcome measures.


In the total study population, 72/1109 (6.5 %) patients experienced symptomatic UTIs and among these 11 (0.9 % of total) had urosepsis. Out of 72, 53 (73.6 %) symptomatic UTIs were caused by fluoroquinolone-resistant strains. Out of 632, 10 (1.6 %) patients in Group 1 and 62/477 (12.9 %) patients in Group 2 had symptomatic UTIs (p < 0.001); in particular, 2/632 (0.3 %) patients in Group 1 and 9/477 (1.8 %) patients in Group 2 had urosepsis (p < 0.001). No differences were reported in terms of adverse events (0.6 vs 0.4 %; p = 0.70). A Charlson comorbidity index ≤1 and type of antimicrobial prophylaxis (FT) were found to be associated with a lower probability of symptomatic UTIs in the multivariate model.


Antibiotic prophylaxis with FT for TR-PB had a lower rate of adverse events and a lower rate of symptomatic UTIs as compared with CIP. Fosfomycin trometamol appears as an attractive alternative prophylactic regimen in prostate biopsies.

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We are grateful to all members of the microbiological departments in all centers for their assistance and to Professor John Denton for manuscript language revision.

Authors’ contribution

Cai T. and Gallelli L. contributed to study conception and design; Cocci A., Tiscione D., Verze P., Lanciotti M., Vanacore D., Rizzo M., Gacci M., Saleh O., Damiano R., Palmieri A., Malossini G. and Liguori G helped in the acquisition of data; Cai T., Verze P. and Tiscione D. analyzed and interpreted the data; Cai T. and Gallelli L. drafted the manuscript; Wagenlehner F., Naber K., Mirone V. and Bjerklund Johansen acknowledged for critical revision and supervisions; and Bjerklund Johansen T.E., Naber K., Bartoletti R., Mirone V., Carini M. and Trombetta C. supervised the intellectual concept.

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Corresponding author

Correspondence to Tommaso Cai.

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Conflict of interest

Tommaso Cai has received grant from Zambon as speaker at scientific meeting; Kurt Naber and Florian Wagenlehner are consultant for and have received research support and grant as speakers at scientific meeting from Zambon.

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Cai, T., Gallelli, L., Cocci, A. et al. Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: fosfomycin trometamol, an attractive alternative. World J Urol 35, 221–228 (2017).

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  • Prostate biopsy
  • Fosfomycin trometamol
  • Fluoroquinolone
  • Prophylaxis
  • Transrectal ultrasonography
  • Urinary tract infection