Reduced Risk of Sepsis after Prostate Biopsy Using a Cephalosporin-Fluoroquinolone Antibiotic Regimen and Isopropyl Alcohol Needle Washing

Published:February 27, 2018DOI:


      To compare 3 prophylactic regimens to assess their impact on postbiopsy sepsis incidence.


      Data were reviewed for 829 consecutive patients who underwent prostate biopsy in a community practice setting between January 2013 and October 2017. Group 1 patients received ciprofloxacin 500 mg two times a day orally for 4 days starting the day prior to biopsy and gentamicin 80 mg intramuscularly 20 minutes prior to biopsy. From April 2015 to October 2017, 2 groups of patients were followed in parallel in a randomized manner. Group 2 received ciprofloxacin 500 mg two times a day orally for 4 days starting the day prior to biopsy and ceftriaxone 1 g intramuscularly 20 minutes prior to biopsy. Group 3 received the same antibiotic regimen as group 2 and also underwent isopropyl alcohol needle washing.


      All study groups were demographically equivalent. Microscopic bacterial counts were substantially decreased after isopropyl alcohol needle washing. Incidence of postbiopsy sepsis in groups 1 (n = 313), 2 (n = 259), and 3 (n = 257) was 3.8%, 2%, and 0%, respectively (analysis of variance; P = .006). Risk factors for sepsis included elevated body mass index, Charlson Comorbidity Score, and presence of type 2 diabetes mellitus.


      There was a significant reduction in the incidence of sepsis after prostate biopsy using a combination of a ciprofloxacin-ceftriaxone antibiotic regimen and isopropyl alcohol needle washing. The technique for needle washing is inexpensive and quick, and can be easily adopted into current biopsy protocols.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Liss M.A.
        • Ehdaie B.
        • Loeb S.
        • et al.
        An update of the American Urological Association white paper on the prevention and treatment of the more common complications related to prostate biopsy.
        J Urol. 2017; 198: 329-334
        • Loeb S.
        • Carter H.B.
        • Berndt S.I.
        • Ricker W.
        • Schaeffer E.M.
        Complications after prostate biopsy: data from SEER-Medicare.
        J Urol. 2011; 186: 1830-1834
        • Toner L.
        • Bolton D.M.
        • Lawrentschuk N.
        Prevention of sepsis prior to prostate biopsy.
        Investig Clin Urol. 2016; 57: 94-99
        • Roberts M.J.
        • Bennett H.Y.
        • Harris P.N.
        • et al.
        Prostate biopsy-related infection: a systematic review of risk factors, prevention strategies, and management approaches.
        Urology. 2017; 104: 11-21
        • Wolf Jr, J.S.
        • Bennett C.J.
        • Dmochowski R.R.
        • et al.
        Best practice policy statement on urologic surgery antimicrobial prophylaxis.
        J Urol. 2008; 179: 1379-1390
        • Batura D.
        • Rao G.G.
        • Bo Nielsen P.
        • Charlett A.
        Adding amikacin to fluoroquinolone-based antimicrobial prophylaxis reduces prostate biopsy infection rates.
        BJU Int. 2011; 107: 760-764
        • Womble P.R.
        • Linsell S.M.
        • Gao Y.
        • et al.
        A statewide intervention to reduce hospitalizations after prostate biopsy.
        J Urol. 2015; 194: 403-409
        • Abughosh Z.
        • Margolick J.
        • Goldenberg S.L.
        • et al.
        A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy.
        J Urol. 2013; 189: 1326-1331
        • Auffenberg G.B.
        • Qi J.
        • Gao Y.
        • et al.
        Evaluation of a needle disinfectant technique to reduce infection-related hospitalisation after transrectal prostate biopsy.
        BJU Int. 2017; 121: 232-238
        • Issa M.M.
        • Al-Qassab U.A.
        • Hall J.
        • Ritenour C.W.
        • Petros J.A.
        • Sullivan J.W.
        Formalin disinfection of biopsy needle minimizes the risk of sepsis following prostate biopsy.
        J Urol. 2013; 190: 1769-1775
        • Koc G.
        • Un S.
        • Filiz D.N.
        • Akbay K.
        • Yilmaz Y.
        Does washing the biopsy needle with povidone-iodine have an effect on infection rates after transrectal prostate needle biopsy?.
        Urol Int. 2010; 85: 147-151
        • Liss M.A.
        • Kim W.
        • Moskowitz D.
        • Szabo R.J.
        Comparative effectiveness of targeted vs empirical antibiotic prophylaxis to prevent sepsis from transrectal prostate biopsy: a retrospective analysis.
        J Urol. 2015; 194: 397-402
        • Zembower T.R.
        • Maxwell K.M.
        • Nadler R.B.
        • et al.
        Evaluation of targeted antimicrobial prophylaxis for transrectal ultrasound guided prostate biopsy: a prospective cohort trial.
        BMC Infect Dis. 2017; 17: 401
        • Adibi M.
        • Hornberger B.
        • Bhat D.
        • Raj G.
        • Roehrborn C.G.
        • Lotan Y.
        Reduction in hospital admission rates due to post-prostate biopsy infections after augmenting standard antibiotic prophylaxis.
        J Urol. 2013; 189: 535-540
        • Lorber G.
        • Benenson S.
        • Rosenberg S.
        • Gofrit O.N.
        • Pode D.
        A single dose of 240 mg gentamicin during transrectal prostate biopsy significantly reduces septic complications.
        Urology. 2013; 82: 998-1002
        • Raman J.D.
        • Rjepaj C.
        • Otteni C.
        A single 80 mg intravenous gentamicin dose prior to prostate needle biopsy does not reduce procedural infectious complications.
        Cent European J Urol. 2015; 68: 229-231
        • Marino K.
        • Parlee A.
        • Orlando R.
        • Lerner L.
        • Strymish J.
        • Gupta K.
        Comparative effectiveness of single versus combination antibiotic prophylaxis for infections after transrectal prostate biopsy.
        Antimicrob Agents Chemother. 2015; 59: 7273-7275
        • Lee J.K.
        • Lee S.
        • Hong S.K.
        • Byun S.S.
        • Lee S.E.
        Clinical importance of the antibiotic regimen in transrectal ultrasound-guided biopsy: quinolone versus cephalosporin.
        BMC Urol. 2016; 16: 51
        • Lundstrom K.J.
        • Drevin L.
        • Carlsson S.
        • et al.
        Nationwide population based study of infections after transrectal ultrasound guided prostate biopsy.
        J Urol. 2014; 192: 1116-1122