Transperineal urological procedures: prostate biopsy or fiducial marker insertion

Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis) and the general principles of surgical antibiotic prophylaxis for urological surgery. Surgical antibiotic prophylaxis is recommended for transperineal prostate biopsy or fiducial marker insertion, despite limited data to support its use.

Patients undergoing transperineal prostate biopsy or fiducial marker insertion should be screened for bacteriuria preoperatively (see Screening for preoperative bacteriuria). For patients treated for bacteriuria preoperatively, modify the choice of surgical antibiotic prophylaxis based on the results of culture and susceptibility testing.

For prophylaxis for transperineal prostate biopsy or fiducial marker insertion, in the absence of culture and susceptibility test results, use:

cefazolin 2 g intravenously, within the 60 minutes before the procedure; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, urological: transperineal prostate biopsy cefazolin

For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, use cefazolin as above. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.

For patients with immediate severe or delayed severe hypersensitivity to penicillins, use:

gentamicin 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before the procedure¹ ² ; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed surgical prophylaxis, urological: transperineal prostate biopsy gentamicin

PLUS EITHER

1 vancomycin 15 mg/kg up to 2 g intravenously, started within the 120 minutes before the procedure (recommended rate 10 mg/minute)³ ; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed surgical prophylaxis, urological: transperineal prostate biopsy vancomycin

OR

2 clindamycin 600 mg intravenously, within the 120 minutes before the procedure; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, urological: transperineal prostate biopsy clindamycin

¹ If the patient is obese (for adults, body mass index 30 kg/m² or more), use adjusted body weight (see ../Aminoglycoside-use-in-special-patient-groups/c_ABG_Aminoglycoside-use-in-special-patient-groups_topic_5.html#c_ABG_Aminoglycoside-use-in-special-patient-groups_topic_5__fig-504) to calculate the dose. Return

² Do not use gentamicin for surgical prophylaxis in adults with a CrCl less than 20 mL/min; seek expert advice.Return

³ It is the consensus view of the Antibiotic Expert Groups that the vancomycin infusion should be started at least 15 minutes before the procedure to ensure adequate blood and tissue concentrations at the time of incision and allow potential infusion-related toxicity to be recognised before induction of anaesthesia. Return