1 3 World J Urol DOI 10.1007/s00345-016-1985-1 ORIGINAL ARTICLE Zero hospital admissions for infection after 577 transperineal prostate biopsies using single-dose cephazolin prophylaxis Lana Pepdjonovic 1 · Guan Hee Tan 2,3 · Sean Huang 1 · Sarah Mann 1 · Mark Frydenberg 1,4 · Daniel Moon 1 · Uri Hanegbi 1 · Adam Landau 1 · Ross Snow 1 · Jeremy Grummet 1,3,4 Received: 25 April 2016 / Accepted: 2 December 2016 © Springer-Verlag Berlin Heidelberg 2016 Introduction Prostate biopsies are essential in the diagnosis of prostate cancer and therefore are a common procedure performed by urologists [1, 2]. The most frequently used approach to prostate biopsy is via the transrectal route guided by ultra- sound imaging (TRUS biopsy) [2–4]. It is the method of choice amongst many urologists as it can be performed quickly under local anaesthesia [5]. However, in recent years, there have been increasing concerns that this approach is associated with rising rates of infective com- plications. Nam et al. [6] reported a fourfold increase in the admissions to hospital for complications from TRUS biopsy comparing the years 1996 and 2005, which were mostly due to infection. The alternative approach is transperineal biopsy of prostate (TPB). This approach has increased in popular- ity as the 2015 European Association of Urology (EAU) guidelines on prostate cancer recommended (Grade B) that either transrectal or transperineal biopsy could be used in the initial diagnosis of prostate cancer [4]. Transperineal biopsy of prostate typically requires the patient to be under general or regional anaesthesia, especially when a template grid is used to guide the biopsy needle [3] and is therefore performed in the operating theatre. Furthermore, TPB equipment is more expensive and complicated than that used for TRUS biopsy. TPB is a safer alternative as TRUS biopsies have rising infective complications [1, 6] and the emergence of multi-resistant bacteria [7, 8]. In a previous report, our group pooled data from 16 studies and found the overall readmission rate for sepsis after TPB to be 0.076% [9]. Currently, there have been very few studies with large sample sizes that have assessed sepsis post-TPB [10–12]. In addition, the larger studies are retrospective [10, 11] Abstract Purpose To determine the rate of hospital admissions for infection after transperineal biopsy of prostate (TPB) with single-dose cephazolin prophylaxis using a prospective database. Method Between April 2013 and February 2016, 577 patients undergoing TPB had 2 g of cephazolin given intra- venously at induction of anaesthesia. Data collected from these patients included age, PSA, prostate volume, number of cores taken and post-operative complications. Results No patients were readmitted to hospital with infec- tion post-TPB. Seven patients developed acute urinary retention, and one patient developed clinical prostatitis that was treated with oral antibiotics in the community. Conclusion It is safe to use single-dose cephazolin only as antibiotic prophylaxis prior to TPB, negating the need for quinolones. This study supports Australia’s current Thera- peutic Guidelines recommendation for TPB prophylaxis and the existing evidence that sepsis post-TPB is a rare complication. Whether any antibiotic prophylaxis is needed at all for TPB is the subject of a future study. Keywords Transperineal biopsy · Prostate · Antibiotic prophylaxis · Cephazolin * Lana Pepdjonovic lanapep@gmail.com 1 Australian Urology Associates, Melbourne, VIC, Australia 2 Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia 3 Department of Urology, Alfred Health, Melbourne, VIC, Australia 4 Department of Surgery, Monash University, Melbourne, VIC, Australia