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• W3006115026 abstract "You have accessJournal of UrologyReview Article1 Aug 2020Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-AnalysisThis article is commented on by the following:Editorial Comments on Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-AnalysisEditorial Comments on Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis Adrian Pilatz, Konstantinos Dimitropoulos, Rajan Veeratterapillay, Yuhong Yuan, Muhammad Imran Omar, Steven MacLennan, Tommaso Cai, Franck Bruyère, Riccardo Bartoletti, Bela Köves, Florian Wagenlehner, Gernot Bonkat, and Benjamin Pradere Adrian PilatzAdrian Pilatz *Correspondence: Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Str. 7, 35392Giessen , Germany telephone: +49-641-985-56362; FAX: +49-641-985-44577; email: E-mail Address: [email protected] Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany Equal study contribution. More articles by this author , Konstantinos DimitropoulosKonstantinos Dimitropoulos Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK Equal study contribution. More articles by this author , Rajan VeeratterapillayRajan Veeratterapillay Freeman Hospital, Newcastle Upon Tyne, UK More articles by this author , Yuhong YuanYuhong Yuan Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada More articles by this author , Muhammad Imran OmarMuhammad Imran Omar Guidelines Office, European Association of Urology, Arnhem, The Netherlands More articles by this author , Steven MacLennanSteven MacLennan Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom More articles by this author , Tommaso CaiTommaso Cai Department of Urology, Santa Chiara, Reg. Hospital, Trento, Italy More articles by this author , Franck BruyèreFranck Bruyère Urologie, CHRU Bretonneau, Tours, France Université Francois Rabelais, PRES Centre Val de Loire, Tours, France More articles by this author , Riccardo BartolettiRiccardo Bartoletti Department of Translational Research and New Technologies, University of Pisa, Italy More articles by this author , Bela KövesBela Köves Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary More articles by this author , Florian WagenlehnerFlorian Wagenlehner Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany More articles by this author , Gernot BonkatGernot Bonkat alta uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry, University Basel, Basel, Switzerland More articles by this author , and Benjamin PradereBenjamin Pradere Urologie, CHRU Bretonneau, Tours, France Université Francois Rabelais, PRES Centre Val de Loire, Tours, France More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000814AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract Purpose: Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been banned by the European Commission. In this systematic review we summarize the evidence for different antibiotic prophylaxis regimens. Materials and Methods: We searched MEDLINE®, Embase® and Cochrane Database for randomized controlled trials (inception to October 2019) assessing antimicrobial interventions in prostate biopsy. Primary outcome was infectious complications. Exclusion criteria were simultaneous interfering interventions. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used to assess the certainty of evidence. Protocol was registered with PROSPERO (CRD42015026354). Results: Overall 59 randomized controlled trials (14,153 participants) and 7 different antimicrobial interventions were included. Antibiotic prophylaxis reduced infectious complications compared to no prophylaxis (RR 0.56, 95% CI 0.40–0.77, p=0.0005, I2=15%, participants 1,753, studies 11). A short-term prophylaxis (single shot to 3 days) was inferior to a long-term prophylaxis (1 to 7 days) with fluoroquinolone (RR 1.89, 95% CI 1.37–2.61, p=0.0001, I2=0%, participants 3,999, studies 17). Fosfomycin trometamol was an alternative to fluoroquinolone with reduced rates of infectious complications (RR 0.49, 95 CI 0.27–0.87, p=0.02, I2=54%, participants 1,239, studies 3). Empiric prophylaxis was inferior to targeted prophylaxis (RR 1.81, 95% CI 1.28–2.55, p=0.0008, I2=48%, participants 1,511, studies 6). Standard prophylaxis was inferior to augmented prophylaxis (using multiple rather than single agent) using a fixed model (RR 2.10, 95% CI 1.53–2.88, p <0.0001, I2=71%, participants 2,597, studies 9), but not using a random model (p=0.07). No difference was observed in infectious complications based on route or timing of antimicrobial prophylaxis. The certainty of evidence was rated as low/very low. Conclusions: In countries where fluoroquinolones are allowed as antibiotic prophylaxis, a minimum of a full 1-day administration as well as targeted therapy in case of fluoroquinolone resistance is recommended. In countries with a ban on fluoroquinolones, fosfomycin is a good alternative, as is augmented prophylaxis, although no established standard combination exists to date. Abbreviations and Acronyms MA meta-analysis RCT randomized controlled trial RoB risk of bias SR systematic review UTI urinary tract infection Prostate cancer is the most common cancer in men.1 It is estimated that there are more than 3.6 million men with prostate cancer in United States.2 Prostate cancer is diagnosed on the histological evidence of malignancy in prostate biopsies or other metastatic tissue. Indications for prostate biopsy include suspicion of prostate cancer by digital rectal examination, elevation of prostate specific antigen, repeat biopsy in case of active surveillance and suspicious imaging.3,4 A recent estimate indicates that more than 2 million biopsies are performed annually in the United States and Europe.5 Ultrasound guided prostate biopsy, which can be performed by transrectal or transperineal approach, is the gold standard for prostate cancer diagnosis.6–8 Fluoroquinolones have been traditionally used for antibiotic prophylaxis. However, overuse and misuse of fluoroquinolones have resulted in an increase in post-biopsy infections worldwide recently.9,10 One of the major risk factors is fluoroquinolone resistant bacteria in the rectal flora, which could be linked to increased infection rates following prostate biopsy.11 In addition, the European Commission has recently banned fluoroquinolones for antibiotic prophylaxis in urological operations and diagnostic interventions due to a negative benefit-risk balance.12 Therefore, the purpose of this comprehensive systematic review and meta-analysis is to summarize the evidence of which antibiotic strategies are effective for reducing the risk of infectious complications for men undergoing prostate biopsy. Materials and Methods Evidence Acquisition We followed the PRISMA guidance and the Cochrane Handbook for systematic reviews of interventions.13,14 The protocol was registered at PROSPERO (CRD42015026354). The detailed PICO (Population, Intervention, Comparison and Outcomes) design is provided in supplementary Appendix 1 (https://www.jurology.com). Literature Search The MEDLINE, Embase, LILACS, CENTRAL, Cochrane Database of Systematic Reviews databases and clinicaltrial.gov were searched (last search October 10, 2019). The grey literature was searched through opengrey.eu and oclc.org. Potentially eligible trials were also identified by searching the reference lists of trials, reviews and health technology assessment reports (YY). There were no date or language restrictions. The search strategy is included in supplementary Appendix 2 (https://www.jurology.com). Types of Outcome Measures Primary outcome was pooled infectious complications (calculated by summing all types of infectious complications reported, ie fever, sepsis, symptomatic UTI). This approach was chosen since in many studies investigating post-biopsy complications a distinction between severe infections (eg sepsis) and mild infections (eg cystitis) is not reported in detail (supplementary table 1, https://www.jurology.com). Secondary outcome was hospitalization due to infectious complications. Data Collection and Analysis Two reviewers (AP, BP or RV) independently performed abstract screening, full-text screening and data extraction. Any disagreements were resolved via discussion or consultation with another reviewer (MIO, SM). Study authors were contacted to provide missing information. Fifteen nonEnglish articles were evaluated in the corresponding languages by members of the author team (supplementary Appendix 3, https://www.jurology.com). Three Japanese articles were translated into English by professional translators. The risk of bias was independently assessed by 2 reviewers (RV, KD) using the Cochrane RoB assessment tool.14,15 Any disagreements were resolved via discussion or consultation with another reviewer (MIO, SM). The GRADE approach was used to assess the certainty of evidence for each comparison (MIO, SM).14 Statistical Analysis The meta-analysis was performed using Review Manager (RevMan) version 5.3. A fixed effects model was used to calculate pooled estimates of treatment effects across similar studies and their 95% CIs. We used risk ratio for dichotomous outcomes. We identified heterogeneity by visually inspecting forest plots and using a standard chi-square test with a significance level of α=0.1. We also considered the I2 statistic, which quantifies inconsistency across trials to assess the impact of heterogeneity on the meta-analysis. Where there was evidence of heterogeneity we attempted to determine possible reasons by examining individual trials, subgroup characteristics or by using a random effects model.14 We expected that the type of antibiotics used within a particular class of antibiotics could introduce clinical heterogeneity and, therefore, to explore this further we performed subgroup analysis. Results Literature Search and Characteristics of the Included Studies We identified 3,044 citations and of those 98 were selected for full-text screening. Reasons for exclusion are provided in supplementary table 2 (https://www.jurology.com). A total of 59 RCTs were included in the SR (supplementary Appendix 2, https://www.jurology.com). The inclusion process is illustrated in a PRISMA diagram (supplementary fig. 1, https://www.jurology.com). For all included studies we provide detailed study characteristics in supplementary Appendix 4 (https://www.jurology.com). All 59 RCTs could be categorized into one of 7 different interventions. Due to a limitation of words and the internationally very different management of hospitalization of patients with UTIs, the results of this secondary outcome are presented in supplementary Appendix 5 (https://www.jurology.com). RoB Assessment Random sequence generation was judged to be high in 1, unclear in 40 and low in 18 studies. Allocation concealment was judged high in 1, unclear in 5, and low in 4 studies. Overall 43 studies were judged as high, 12 as unclear and 4 as low risk for blinding of participants and personnel. Four studies were judged as having high RoB for blinding of outcomes, and 5 studies were judged as high and 13 as unclear for attrition bias. Thirteen studies were judged as unclear for reporting bias. One study was judged as high for other bias and 21 rated as unclear. The RoB assessment is illustrated in supplementary figure 2 (https://www.jurology.com). Grading of Recommendations, Assessment, Development and Evaluations The certainty of evidence was mainly downgraded due to study design. Some evidence was also downgraded because of clinical and statistical heterogeneity (supplementary Appendix 6, https://www.jurology.com). Intervention 1: Antibiotic vs No Antibiotic Prophylaxis Twelve studies evaluated the value of antibiotic prophylaxis to reduce infectious complications and included 1,801 men (supplementary Appendix 2, https://www.jurology.com). There were 64 events among 1,141 patients (5.6%) randomized to antibiotic prophylaxis and 71 among 612 patients (11.6%) randomized to placebo or no antibiotic prophylaxis. The comparison was significant (RR 0.56, 95% CI 0.40–0.77; participants 1,753, studies 11, I2=15%, low certainty; supplementary fig. 3, https://www.jurology.com). Intervention 2: Antibiotic Prophylaxis before vs after Biopsy Two studies evaluated the point of antibiotic prophylaxis and compared prophylaxis before vs after biopsy (supplementary Appendix 2, https://www.jurology.com). MA showed 8 infections among 285 men (2.8%) randomized to antibiotic prophylaxis before biopsy and 4 among 276 men (1.5%) randomized to antibiotic prophylaxis after biopsy (RR 1.77, 95 CI 0.58–5.45, participants 561, studies 2, I2=0%, very low certainty; supplementary fig. 4, https://www.jurology.com). Intervention 3: Duration of Antibiotic Prophylaxis The duration of antibiotic prophylaxis was evaluated in 18 studies including 4,091 men undergoing prostate biopsy (supplementary Appendix 2, https://www.jurology.com). Duration of antibiotic prophylaxis varied across different studies. MA showed 97 infectious complications in 1,980 men randomized to the respective shorter prophylaxis and 52 events in those 2,019 randomized to the respective longer antibiotic prophylaxis. The comparison was significant (RR 1.89, 95% CI 1.37–2.61, participants 3,999, studies 17, I2=0%, low certainty; supplementary fig. 5, https://www.jurology.com). Three subgroup analyses were possible (single dose vs 3 days, 1 day vs 3 days, 1 day vs 5 to 7 days). Analysis of the 6 studies investigating a single dose regimen without complete 24-hour effect vs a 3-day regimen revealed 23 events in 543 men randomized to single dose and 6 events in 557 men in the 3-day arm. The difference was statistically significant (RR 3.69, 95% CI 1.56–8.69, participants 1,100, studies 6, I2=0%, very low certainty; supplementary fig. 5, https://www.jurology.com). In the 6 studies comparing a 1-day vs a 3-day regimen 26 events occurred in 834 men and 17 events in 843 men, respectively. The difference was not statistically significant (RR 1.57, 95% CI 0.86–2.87, participants 1,677, studies 5, I2=0%, very low certainty; supplementary fig. 5, https://www.jurology.com). Finally, in the 4 studies evaluating a 1-day regimen vs a 5 to 7-day regimen 37 infections were reported among 527 men in the 1-day arm and 20 infections among the 543 men in the 5 to 7-day arms. The difference was statistically significant (RR 1.88, 95% CI 1.11–3.19, participants 1,070, studies 4, I2=0%, very low certainty; supplementary fig. 5, https://www.jurology.com). Intervention 4: Evaluation of Different Antibiotic Classes Due to the outstanding importance of fluoroquinolones all other comparisons of different antibiotic classes can be found in supplementary Appendix 7 (https://www.jurology.com). A total of 14 studies compared nonfluoroquinolones or alternative fluoroquinolone vs standard fluoroquinolones (supplementary Appendix 2, https://www.jurology.com). MA showed 46 events among 1,949 men randomized to nonfluoroquinolones or alternative fluoroquinolone and 75 events among 1,884 men randomized to standard fluoroquinolone prophylaxis. The difference was statistically significant (RR 0.61, 95 CI 0.43–0.87, participants 3,833, studies 12, I2=44%, very low certainty; supplementary fig. 6, https://www.jurology.com). Of interest is a subgroup analysis with 3 studies comparing fosfomycin trometamol (2 studies single dose, 1 study 2 doses) vs standard fluoroquinolones (2 studies 5 days, 1 study single dose).16–18 Here, in the fosfomycin group 17 events occurred in 643 men, while 33 events occurred in 596 men in the fluoroquinolone group. The difference was statistically significant (RR 0.49, 95 CI 0.27–0.87, participants 1,239, studies 3, I2=54%, very low certainty; supplementary fig. 6, https://www.jurology.com). Intervention 5: Nonoral Antibiotic Prophylaxis vs Oral Antibiotic Prophylaxis Five studies evaluated different routes of delivery of antimicrobial prophylaxis (supplementary Appendix 2, https://www.jurology.com). Among 293 men randomized to nonoral prophylaxis 9 events were recorded, while among 283 men in the oral prophylaxis group 11 events were reported. The difference was not statistically significant (RR 0.82, 95% CI 0.38–1.81, participants 576, studies 4, I2=0%, very low certainty; supplementary fig. 7, https://www.jurology.com). Intervention 6: Empiric vs Targeted Antibiotic Prophylaxis Six studies evaluated the use of targeted antibiotic prophylaxis (supplementary Appendix 2, https://www.jurology.com). MA showed 75 infections among 767 men in the empiric group and 41 among 744 in the targeted group. The difference was statistically significant (RR 1.81, 95% CI 1.28–2.55, participants 1,511, studies 6, I2=48%, low certainty; supplementary fig. 8, https://www.jurology.com). Intervention 7: Single Antibiotic Agent vs Multiple Agents (augmented prophylaxis) Ten studies evaluated the use of more than 1 agent for antibiotic prophylaxis compared to the standard single agent regime (supplementary Appendix 2, https://www.jurology.com). The antibiotic combinations differed largely (supplementary Appendix 4, https://www.jurology.com). There were 103 events among 1,295 men randomized to standard single agent prophylaxis and 50 events among 1,302 men randomized to multiple agent prophylaxis. The difference was statistically significant using a fixed model (RR 2.10, 95% CI 1.53–2.88, participants 2,597, studies 9, I2=71%, very low certainty; supplementary fig. 9, a, https://www.jurology.com), but not using a random model (RR 2.10, 95% CI 0.95–4.65, participants 2,597, studies 9, I2=71%, very low certainty; supplementary fig. 9, b, https://www.jurology.com). Discussion This review investigated antimicrobial strategies which aimed to reduce the risk of infectious complications as well as hospitalization due to infectious complications. Infectious complications following prostate biopsy can not only be reduced by antibiotic prophylaxis but also by nonantibiotic strategies. These include the biopsy route, rectal preparation and other technical modifications such as disinfection and size of the biopsy needle. These should, of course, be considered first and foremost.10,19 In contrast to other previous SRs we also included studies reporting on patients rendered as higher risk for post-biopsy infection (eg indwelling catheter, immunosuppression, prosthesis).20–22 Although in the PICO design we explicitly searched for studies that randomize patients with risk factors for infectious complications into different therapy arms, we did not find such a RCT that could be used to make a tailor-made therapy decision. The duration of antibiotic prophylaxis is a matter of ongoing debate. It should be noted that all studies exclusively used fluoroquinolones in this context. Our meta-analyses show that a single dose with an antibiotic with less than 24 hours’ antibacterial effect is clearly inferior to a 3-day prophylaxis. In contrast, a full 1-day prophylaxis was comparable to a 3-day prophylaxis. A full 1-day prophylaxis was inferior compared to a 5 to 7-day prophylaxis. However, this was only related to 1 study from 1996.23 Without this study no significant difference would have been evident. Summarizing the data, a full 1-day prophylaxis is recommendable. This is a clear change in evidence, while a previous Cochrane review and another MA identified no significant differences between a single shot and multiple doses regarding fever, hospitalization, sepsis and UTI.20,22 Of note, several previous SRs and/or MAs mixed up single shot and full 1-day prophylaxis when comparing to a 3-day prophylaxis.20,22,24 The optimal antibiotic agent for prophylaxis is still unknown. This is also due to clear geographical differences in antibiotic resistance so that knowledge of the local antimicrobial resistance pattern is important.25,26 In accordance with previous MAs the different antibiotic classes are quite comparable regarding the infectious outcome.20,22 However, due to the increase of fluoroquinolone resistance and the recent decision of the European Commission to ban fluoroquinolones from antibiotic prophylaxis in urological surgery, alternatives are necessary.12 Here, the MA of 3 RCTs significantly favored fosfomycin,16–18 which is in line with 2 other MAs that also included nonRCTs.27,28 Of note, the RCTs were performed in countries with high fluoroquinolone resistance. In contrast, in a recent large Canadian nested case-control study with more than 9,000 patients fosfomycin (single dose as well as 2 doses) was inferior to ciprofloxacin (3 days or single dose), which limits the generalizability of the use of fosfomycin.29 Other possibilities are cephalosporins30,31 and aminoglycosides32,33 in antibiotic prophylaxis. Here, 2 RCTs per substance class were compared with fluoroquinolones, whereby no significant differences were observed. In agreement with other previous MAs, we could not see any differences in the outcome with respect to the route of antibiotic administration.20,22 Considering the increase in fluoroquinolone resistance of fecal isolates, the use of a rectal swab with subsequent bacterial culture for pre-biopsy screening could offer individual targeted antimicrobial therapy. A SR was performed on this issue and included 15 studies with 12,320 patients.34 Only 1 study was a RCT and 8 studies were of retrospective cohort design. The authors calculated a significantly higher infection rate of 3.4% (95% CI 2.6–4.3) in the standard prophylaxis group compared to 0.8% (95% CI 0.4–1.3) in the targeted prophylaxis group. Our MA of 6 studies confirmed the benefit of targeted prophylaxis.35–40 However, the largest RCT used only a single shot targeted prophylaxis compared to a 3-day regimen of standard or augmented prophylaxis and showed comparable infectious complications with targeted and empiric prophylaxis.35 This is in concordance with our analysis showing that a single shot prophylaxis is insufficient. Two previous MAs systematically assessed the value of augmented prophylaxis and identified significantly fewer infectious combinations when pooling 3 RCTs alone22 or in combination with other nonRCTs.41 Our analysis of 10 RCTs including high risk patients confirmed the benefit of augmented prophylaxis when using a fixed model. The study by Fahmy et al (fosfomycin vs ciprofloxacin plus metronidazole) results in a high heterogeneity of all included studies (I2=71%) so that the comparison is not significant when using a random model.42 Although it contradicts the principles of antibiotic stewardship,43,44 augmented prophylaxis is standard of care in many hospitals and private practices, among other things due to a lack of compliance with the sole use of oral prophylaxis.35,45–47 The major strengths of this SR are 1) it is the most detailed one dealing with different aspects of antibiotic prophylaxis, 2) it includes RCTs without language and publication date limitations, and 3) it includes studies reporting on patient risk factors rendered as higher risk for post-biopsy infection, which were often excluded in previous MAs but well reflect the clinical situation. Limitations of this article are 1) it is a systematic review with meta-analysis and not a white paper (eg American Urological Association white paper),10 so that no flow scheme can be provided, 2) only antibiotic interventions were considered, as implementation of nonantibiotic interventions (eg biopsy route, enema) would have completely overloaded the study, 3) the management of a hospitalization due to infectious complications after prostate biopsy is markedly different worldwide and therefore not very objective, so that all data on hospitalization can be found in the supplementary material, 4) all infection complications were summed up, since in many included studies a distinction between severe infections (eg sepsis) and mild infections (UTI) is not reported in detail, and 5) no RCTs for antibiotic prophylaxis in transperineal prostate biopsy exist so far. Conclusions The available evidence suggests that in countries where fluoroquinolones are allowed as antibiotic prophylaxis a minimum of a full 1-day administration as well as targeted therapy in case of fluoroquinolone resistance is recommended for patients undergoing transrectal biopsy. In countries where fluoroquinolones are prohibited for antibiotic prophylaxis of prostate biopsy, cephalosporins, aminoglycosides or fosfomycin can be used as individual substances. In the available RCTs fosfomycin was superior to fluoroquinolones but routine general use must be critically assessed due to relevant infectious complications reported from nonrandomized studies. Another possibility is the use of augmented prophylaxis without fluoroquinolone, although no standard combination has been established to date. Acknowledgments Many thanks to Robert Pickard (deceased), Newcastle upon Tyne, United Kingdom, for initiation of this review. 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Google Scholar No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPontes-Junior J, Freire T, Pugliesi F, de Moura Costa F, de Souza V, Galucci F, Albertini A, Couto A, Murta C, Guglielmetti G, Nahas W, Andriolo Junior A, Neto A and de Almeida Claro J (2022) Effectiveness of Intrarectal Povidone-iodine Cleansing Plus Formalin Disinfection of the Needle Tip in Decreasing Infectious Complications After Transrectal Prostate Biopsy: A Randomized Controlled TrialJournal of Urology, VOL. 208, NO. 6, (1194-1202), Online publication date: 1-Dec-2022.Castellani D, Pirola G, Law Y, Gubbiotti M, Giulioni C, Scarcella S, Wroclawski M, Chan E, Chiu P, Teoh J, Gauhar V and Rubilotta E (2021) Infection Rate after Transperineal Prostate Biopsy with and without Prophylactic Antibiotics: Results from a Systematic Review and Meta-Analysis of Comparative StudiesJournal of Urology, VOL. 207, NO. 1, (25-34), Online publication date: 1-Jan-2022.Pradere B, Veeratterapillay R, Dimitropoulos K, Yuan Y, Omar M, MacLennan S, Cai T, Bruyère F, Bartoletti R, Köves B, Wagenlehner F, Bonkat G and Pilatz A (2020) Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 205, NO. 3, (653-663), Online publication date: 1-Mar-2021.Rizzo M, Liguori G and Trombetta C (2020) Editorial Comments on Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 204, NO. 3, (414-415), Online publication date: 1-Sep-2020.Samarinas M (2020) Editorial Comments on Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 204, NO. 3, (414-414), Online publication date: 1-Sep-2020.Related articlesJournal of Urology16 Jul 2020Editorial Comments on Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-AnalysisJournal of Urology16 Jul 2020Editorial Comments on Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis Volume 204Issue 2August 2020Page: 224-230Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsprostatesepsisantibiotic prophylaxisbiopsyinfectionsAcknowledgmentsMany thanks to Robert Pickard (deceased), Newcastle upon Tyne, United Kingdom, for initiation of this review. Emma Smith from the EAU Guidelines Office and Temitope Adewuyi from Aberdeen University, United Kingdom, provided assistance with the systematic review.MetricsAuthor Information Adrian Pilatz Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany *Correspondence: Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf-Buchheim-Str. 7, 35392Giessen , Germany telephone: +49-641-985-56362; FAX: +49-641-985-44577; email: E-mail Address: [email protected] Equal study contribution. More articles by this author Konstantinos Dimitropoulos Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK Equal study contribution. More articles by this author Rajan Veeratterapillay Freeman Hospital, Newcastle Upon Tyne, UK More articles by this author Yuhong Yuan Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada More articles by this author Muhammad Imran Omar Guidelines Office, European Association of Urology, Arnhem, The Netherlands More articles by this author Steven MacLennan Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom More articles by this author Tommaso Cai Department of Urology, Santa Chiara, Reg. Hospital, Trento, Italy More articles by this author Franck Bruyère Urologie, CHRU Bretonneau, Tours, France Université Francois Rabelais, PRES Centre Val de Loire, Tours, France More articles by this author Riccardo Bartoletti Department of Translational Research and New Technologies, University of Pisa, Italy More articles by this author Bela Köves Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary More articles by this author Florian Wagenlehner Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany More articles by this author Gernot Bonkat alta uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry, University Basel, Basel, Switzerland More articles by this author Benjamin Pradere Urologie, CHRU Bretonneau, Tours, France Université Francois Rabelais, PRES Centre Val de Loire, Tours, France More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. 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