Fosfomycin Trometamol versus Ciprofloxacin for antibiotic prophylaxis prior transrectal ultrasound guided prostate biopsy: a meta-analysis of clinical studies

BACKGROUND: Infectious complications are a major concern after trans-rectal ultrasound-guided prostate needle biopsy (TRUS-PNB). Although Fluoroquinolones are currently the first choice, an increase in resistance has raised the question about its recommendation. Fosfomycin trometamol (FMT) is a wide spectrum oral antibiotic with low bacterial resistance reported. Therefore we performed a systematic review and meta-analysis of clinical studies to assess the comparative prophylactic effectiveness of FMT versus Ciprofloxacin (CIP) in subjects who underwent TRUS-PNB. METHODS: A systematic review was performed between January 1970 and June 2017 using Web of Science, Scopus and PubMed databases to identify relevant studies. Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria was used for article selection. Outcomes of interest were febrile and afebrile urinary tract infection (UTI) and the presence of Fluoroquinolone-resistant (FQR) or extended spectrum beta-lactamase (ESBL) producing uropathogens in urinary cultures. RESULTS: Four studies including 2331 subjects were analyzed, 1088 had used FMT and 1243 CIP as antibiotic prophylaxis previous TRSU-PNB. FMT provided a significantly lower afebrile (OR = 0.21, 95%CI = 0.12 – 0.38, P < 0.001) and febrile (OR = 0.15, 95%CI = 0.07 – 0.31, P < 0.001) UTI than CIP. Among all urine cultures, patients in FMT arm also had a significant lower prevalence of FQR and ESBL (E. coli or K. pneumoniae) microorganisms when compared to CIP group (OR = 0.25, 95% CI = 0.12 – 0.21, P = 0.001 and OR = 0.24, 95% CI = 0.10-0.58, P = 0.001, respectively). CONCLUSION: Antibiotic prophylaxis with FMT prior to TRUS-PNB was associated with lower rates of infectious complication when compared to CIP.