title: Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: fosfomycin trometamol, an attractive alternative.
abstract: OBJECTIVE
  To compare fosfomycin trometamol (FT) and ciprofloxacin (CIP) for antibiotic prophylaxis in transrectal prostate biopsy (TR-PB).
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Santa Chiara Regional Hospital, Largo Medaglie d'Oro, 9, 38123, Trento, Italy. ktommy@libero.it.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Cai
authors.affiliation: Department of Health Science, School of Medicine, University of Catanzaro, Catanzaro, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Gallelli
authors.affiliation: Department of Urology, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cocci
authors.affiliation: Department of Urology, Santa Chiara Regional Hospital, Largo Medaglie d'Oro, 9, 38123, Trento, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Tiscione
authors.affiliation: Department of Urology, University of Naples, Federico II, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Verze
authors.affiliation: Department of Urology, University of Florence, Florence, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Lanciotti
authors.affiliation: Department of Urology, University of Florence, Florence, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Vanacore
authors.affiliation: Department of Urology, University of Trieste, Trieste, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Rizzo
authors.affiliation: Department of Urology, University of Florence, Florence, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.affiliation: Department of Urology, University of Florence, Florence, Italy.
authors.forename: Omar
authors.initials: O
authors.lastname: Saleh
authors.affiliation: Department of Urology, Santa Chiara Regional Hospital, Largo Medaglie d'Oro, 9, 38123, Trento, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Malossini
authors.affiliation: Department of Urology, University of Trieste, Trieste, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Liguori
authors.affiliation: Department of Urology, University of Trieste, Trieste, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Trombetta
authors.affiliation: Department of Urology, University of Catanzaro, Catanzaro, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Rocco
authors.affiliation: Department of Urology, University of Naples, Federico II, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Palmieri
authors.affiliation: Department of Urology, University of Pisa, Pisa, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bartoletti
authors.affiliation: Department of Urology, University of Florence, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.affiliation: Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Giessen und Marburg GmbH, Justus-Liebig-Universität Giessen, Giessen, Germany.
authors.forename: Florian M E
authors.initials: FM
authors.lastname: Wagenlehner
authors.affiliation: Department of Urology, Technical University of Munich, Munich, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Naber
authors.affiliation: Department of Urology, University of Naples, Federico II, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
authors.affiliation: Department of Urology, Oslo University Hospital, Oslo, Norway.
authors.forename: Truls E
authors.initials: TE
authors.lastname: Bjerklund Johansen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002939:Ciprofloxacin / Q000627:therapeutic use*; D015331:Cohort Studies; D005578:Fosfomycin / Q000627:therapeutic use*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D005578:Fosfomycin; D002939:Ciprofloxacin
keywords: Fluoroquinolone; Fosfomycin trometamol; Prophylaxis; Prostate biopsy; Transrectal ultrasonography; Urinary tract infection