Fosfomycin Trometamol for the Prevention of Infectious Complications After Prostate Biopsy: A Consensus Statement by an International Multidisciplinary Group

Truls E Bjerklund Johansen; Ekaterina Kulchavenya; Gretchen M Lentz; David M Livermore; J Curtis Nickel; George Zhanel; Gernot Bonkat

doi:10.1016/j.euf.2021.11.007

Fosfomycin Trometamol for the Prevention of Infectious Complications After Prostate Biopsy: A Consensus Statement by an International Multidisciplinary Group

Eur Urol Focus. 2022 Sep;8(5):1483-1492. doi: 10.1016/j.euf.2021.11.007. Epub 2021 Dec 15.

Authors

Truls E Bjerklund Johansen¹, Ekaterina Kulchavenya², Gretchen M Lentz³, David M Livermore⁴, J Curtis Nickel⁵, George Zhanel⁶, Gernot Bonkat⁷

Affiliations

¹ Department of Urology, Oslo University Hospital, Nydalen, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark. Electronic address: tebj@uio.no.
² Urogenital Department, Novosibirsk Research TB Institute and Novosibirsk Medical University, Novosibirsk, Russian Federation.
³ Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
⁴ Norwich Medical School, University of East Anglia, Norwich, UK.
⁵ Department of Urology, Queens University, Kingston, ON, Canada.
⁶ Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.
⁷ Department of Urology, alta uro AG, Basel, Switzerland.

PMID: 34920977
DOI: 10.1016/j.euf.2021.11.007

Abstract

Context: Transrectal ultrasound-guided prostate biopsy (TRPB) has been a standard of care for diagnosing prostate cancer but is associated with a high incidence of infectious complications.

Objective: To achieve an expert consensus on whether fosfomycin trometamol provides adequate prophylaxis in TRPB and discuss its role as prophylaxis in transperineal prostate biopsy (TPPB).

Evidence acquisition: An international multidisciplinary group of experts convened remotely to discuss how to best use fosfomycin in various clinical settings and patient situations. Six statements related to prostate biopsy and the role of fosfomycin were developed, based on literature searches and relevant clinical experience.

Evidence synthesis: Consensus was reached for all six statements. The group of experts was unanimous regarding fosfomycin as a preferred candidate for antimicrobial prophylaxis in TRPB. Fosfomycin potentially also meets the requirements for empiric prophylaxis in TPPB, although further clinical studies are needed to confirm or refute its utility in this setting. There is a risk of bias due to sponsorship by a pharmaceutical company.

Conclusions: Antimicrobial prophylaxis is mandatory in TRPB, and fosfomycin trometamol is an appropriate candidate due to low rates of resistance, a good safety profile, sufficient prostate concentrations, and demonstrated efficacy in reducing the risk of infectious complications following TRPB.

Patient summary: Patients undergoing transrectal ultrasound-guided prostate biopsy (TRPB) have a high risk of infectious complications, and antimicrobial prophylaxis is mandatory. However, increasing antimicrobial resistance, as well as safety concerns with fluoroquinolones, has restricted the number of antimicrobial options. Fosfomycin trometamol meets the requirements for a preferred antimicrobial in the prophylaxis of TRPB.

Keywords: Antimicrobial prophylaxis; Fosfomycin trometamol; Infectious complications; Transperineal prostate biopsy; Transrectal prostate biopsy.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use
Antibiotic Prophylaxis
Biopsy / adverse effects
Fosfomycin* / therapeutic use
Humans
Male
Prostate / pathology
Tromethamine

Substances

Fosfomycin
Tromethamine
Anti-Bacterial Agents