Infectious and non-infectious complications associated with transrectal MRI-guided prostate biopsy using an alternative antibiotic regimen with oral cefixime

Background Transrectal prostate biopsy has raised concerns due to potential postbiopsy infections. Objective This study evaluated infectious and non-infectious complication rates following transrectal biopsy without bowel preparation, using third-generation cephalosporin prophylaxis instead of resource-intensive targeted approaches. Materials and methods A single-centre retrospective study included biopsy-naïve patients undergoing MRI–ultrasound fusion-guided transrectal systematic and targeted prostate biopsies under local anaesthesia in an outpatient setting. All patients received third-generation cephalosporin prophylaxis, cefixime. The primary endpoint was the 30-day infectious complication rate, including fever, genitourinary infections, additional antibiotic prescriptions, unscheduled office/emergency visits, hospitalisations, or sepsis. Secondary endpoints were non-infectious complications such as gross haematuria, rectal bleeding, or acute urinary retention. Results Data from 336 cases were analysed. No cases of sepsis or positive blood cultures were observed. Infectious complications were uncommon, with fever ≥38°C occurring in 10 patients (2.9%), of whom 6 (1.8%) required hospitalisation. Localised infection, limited to epididymitis, was reported in 5 patients (1.5%) and was managed with additional antibiotics. Overall, 14 patients (4.2%) required unscheduled visits due to complications. Non-infectious complications were infrequent, with haematuria requiring bladder irrigation in 3 patients (0.9%) and acute urinary retention in 2 patients (0.6%). The median pain score during the procedure was 1.8 on a standardised scale. Discussion Transrectal prostate biopsy using third-generation cephalosporin prophylaxis was associated with low infectious and non-infectious complication rates, with no sepsis cases reported. These findings highlight the procedure’s safety and effectiveness, supporting its continued clinical use without the need for intensive prophylactic measures.