# Prophylactic Antibiotic Use in Transperineal Ultrasound-Guided Prostate Biopsy Under Local Anesthesia: A Retrospective Observational Study

## TL;DR

This study found that skipping antibiotics during a specific prostate biopsy procedure does not increase infection risk and highlights smoking as a risk factor for UTIs.

## Contribution

The study provides evidence supporting the safety of omitting prophylactic antibiotics during LATP prostate biopsies.

## Key findings

- Post-biopsy UTI rates were low and similar between groups with and without antibiotics.
- Smoking history was significantly associated with increased UTI risk (p < 0.05).
- No sepsis cases or significant differences in hospital admissions were observed between groups.

## Abstract

Aim: Transperineal prostate biopsy under local anesthesia (LATP) carries a low risk of infection, yet prophylactic antibiotics remain commonly used. This study evaluated infection outcomes with and without antibiotic use during LATP.

Methods: We conducted a retrospective analysis of 186 men undergoing LATP between February 2022 and June 2025 under the care of a single urologist. Patients either received a single prophylactic antibiotic dose (Group 1, n = 91) or no antibiotics (Group 2, n = 95). The primary outcome was urinary tract infection (UTI) within 30 days post-biopsy; secondary outcomes included hospital admissions for infection.

Results: Baseline characteristics were similar between groups. The incidence of post-biopsy UTI was low and did not differ significantly between patients who received antibiotics and those who did not. No cases of sepsis occurred. Hospital admissions for infection-related complications were rare in both groups. A significant association was observed between smoking history and risk of UTI (p < 0.05), whereas other comorbidities showed no association.

Conclusions: In this cohort, the omission of prophylactic antibiotics during LATP prostate biopsy was not associated with an increased risk of infection. These findings support the safety of a no-antibiotic approach and highlight smoking as a potential risk factor for post-biopsy UTI. Broader adoption of selective antibiotic protocols may contribute to improved antimicrobial stewardship without compromising patient safety.