Editing Prostate Biopsy (section)

==== Transrectal ====
*'''<span style="color:#ff0000">Recommended for all patients undergoing prostate biopsy</span>'''
* '''<span style="color:#ff0000">Regimen:</span>'''
** '''[https://pubmed.ncbi.nlm.nih.gov/31441676/ 2019 AUA Antibiotic Prophylaxis Guidelines]: fluoroquinolone OR 1st/2nd/3rd gen. cephalosporin (ceftriaxone commonly used) + aminoglycoside'''
** 2015 CUA Antibiotics Prophylaxis Guidelines: no specific regimen
** Campbell’s: For patients at risk for developing endocarditis or infection of prosthetic joints, pacemakers, and automated implanted cardiac defibrillators, prophylaxis should consist of intravenous ampicillin (vancomycin, if penicillin allergic) and gentamicin preoperatively, followed by 2 to 3 days of an oral fluoroquinolone.
** Presence of fluoroquinolone resistant organisms on a rectal swab culture may not always be associated with clinical infection. 
***A multi-institutional cohort study of 136 men undergoing rectal swab cultures immediately before biopsy found fluoroquinolone resistant E. coli in 22% of cultures. Patients received ciprofloxacin +/- gentamycin for prophylaxis. Post-biopsy fever occurred in 5 patients, and only 1 of them had a positive rectal screen for resistant E. coli.[https://pubmed.ncbi.nlm.nih.gov/21334021/]
** '''The use of targeted prophylaxis after rectal flora swabbing and culture has been shown to have some utility compared with empirical antibiotic prophylaxis in some series'''
* '''<span style="color:#ff00ff">2011 Cochrane review evaluating antibiotic prophylaxis for TRUS biopsy of the prostate</span>[https://pubmed.ncbi.nlm.nih.gov/21563156/]'''
** 19 studies including 3,599 patients.
** '''Comparing antibiotics vs. placebo/no antibiotics''' (9 trials): '''antibiotics significantly reduce risk of (5):'''
**# '''Bacteriuria''' (risk ratio (RR) 0.25)
**# '''UTI''' (RR 0.37)
**# '''Bacteremia''' (RR 0.67)
**# '''Fever''' (RR 0.39)
**# '''Hospitalization''' (RR 0.13)
**#* Most data derived from studies with quinolones
** '''Comparing antibiotics +/- enema, only the risk of bacteremia''' (RR 0.25, 95% CI 0.08-0.75) '''was diminished in the antibiotic + enema group'''
** '''Comparing short-course (1 day) versus long-course (3 days) antibiotics''' (7 trials): '''long course significantly better than short-course treatment only for bacteriuria''' (RR 2.09)
** Comparing '''s'''ingle versus multiple dose: significantly greater risk of bacteriuria for single-dose treatment (RR 1.98)
** Comparing oral versus systemic administration - intramuscular injection (IM), or intravenous (IV) - of antibiotics, no significant differences in the groups for bacteriuria, fever, UTI and hospitalization.
** Zani, Emerson L., Otavio Augusto Camara Clark, and Nelson Rodrigues Netto Jr. "[https://pubmed.ncbi.nlm.nih.gov/21563156/ Antibiotic prophylaxis for transrectal prostate biopsy.]" Cochrane Database of Systematic Reviews 5 (2011).