International Delphi Consensus on Risk Factors Justifying Antibiotic Prophylaxis in Transperineal Prostate Biopsy

International Delphi Consensus on Risk Factors Justifying Antibiotic Prophylaxis in Transperineal Prostate Biopsy | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search International Delphi Consensus on Risk Factors Justifying Antibiotic Prophylaxis in Transperineal Prostate Biopsy FP Stangl , F Wagenlehner , J Kranz , TE Bjerklund Johansen doi: https://doi.org/10.1101/2025.07.15.25331517 FP Stangl 1 Inselspital Bern, Department of Urology , Bern, Switzerland Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: f.stangl{at}dbuag.ch F Wagenlehner 3 Department of Urology, Justus-Liebig University Giessen , Giessen, Germany Find this author on Google Scholar Find this author on PubMed Search for this author on this site J Kranz 2 RWTH Aachen, University Hospital Aachen , Aachen, Germany Find this author on Google Scholar Find this author on PubMed Search for this author on this site TE Bjerklund Johansen 4 Department of Urology, Oslo University Hospital , 0025 Oslo, Norway Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background Transperineal prostate biopsy (TP-Bx) is increasingly favored over the transrectal approach due to its lower rate of infectious complications. Emerging evidence suggests that TP-Bx can often be safely performed without antibiotic prophylaxis in low-risk patients. However, there is no international consensus on the clinical risk factors that justify prophylactic antibiotic use, leading to wide practice variability and concerns regarding antimicrobial stewardship. Objective This Delphi consensus study aims to identify and define procedural, patient-related, and microbiological risk factors that warrant antibiotic prophylaxis in TP-Bx and to establish evidence-informed best practice recommendations. Methods A modified three-round Delphi process will be conducted in accordance with ACCORD and CREDES guidelines. A diverse panel of 50–60 international experts in urology, infectious diseases, microbiology, and antimicrobial stewardship will anonymously evaluate predefined and newly suggested risk factors using a 6-point Likert scale. Consensus will be defined as ≥70% of participants rating an item as highly important (score 5–6) and <15% rating it as unimportant (score 1–2). Items failing to reach consensus in Rounds 1 and 2 will be re-evaluated in subsequent rounds. Outcomes The primary outcome will be a consensus-based list of risk factors justifying antibiotic prophylaxis in TP-Bx. Secondary outcomes include recommendations for diagnostic testing, prophylactic regimens, and thresholds for initiating routine prophylaxis based on institutional infection rates. Dissemination Findings will be submitted for publication in peer-reviewed journals to support global efforts in harmonizing practice and promoting responsible antibiotic use in prostate cancer diagnostics. Background Transperineal prostate biopsy (TP-Bx) is increasingly preferred over the traditional transrectal approach due to its lower rate of infectious complications. Recent high-quality evidence indicates that TP-Bx may be safely performed without antibiotic prophylaxis in low-risk patients 1 - 4 . However, there is currently no international consensus defining which risk factors that justifies periprocedureal prophylaxis. This lack of guidance has led to inconsistent practices worldwide, undermining both patient safety and antimicrobial stewardship. While antibiotic prophylaxis may reduce the risk of infectious complications, indiscriminate use can contribute to antimicrobial resistance and disruption of the microbiome—highlighting the critical balance between individual patient protection and broader antimicrobial stewardship principles 5 - 7 . To address this evidence-to-practice gap, we propose a Delphi consensus study to define a globally applicable set of clinical risk factors that justify antibiotic prophylaxis and provide a best practice recommendation for TP-Bx. Objectives To identify and reach expert consensus on procedural-, patient- and microbiological risk factors that justify antibiotic prophylaxis and do define best practice in patients undergoing transperineal prostate biopsy. Study Design We will employ a modified Delphi method consisting of three sequential and anonymous rounds. The study will adhere to the ACCORD (Accurate Consensus Reporting Document) and CREDES (Conducting and Reporting of Delphi Studies) guidelines to ensure transparency, methodological rigour, and reproducibility. The full protocol will be made publicly available before commencement of the study. Expert Panel We aim to recruit approximately 50-60 experts in the fields of Urology Infectious Diseases and Antimicrobial Stewardship Microbiology Participants will be selected based on Peer-reviewed publications Involvement in guideline panels Recognised clinical or academic leadership Personal experience with TP Bx (requirement for urologists only) Experts will be drawn from across Africa, Asia, Australasia, Europe, Latin America, and North America to ensure global representation. In total 65 Experts will be invited to participate in the Delphi consensus. They will be contacted by email and two reminders will be sent as needed. Anonymity and Data Collection All rounds will be conducted online using a secure survey platform managed by an external provider. Responses will be anonymised to prevent dominance bias and to allow candid input. Round 1 Participants will receive a structured survey comprising A list of risk factors derived from an extensive literature review and from already established frameworks such as ORENUC, as well as recent Delphi consensus work on complicated urinary tract infections 8 , 9 — including, for example, recent UTI, immunosuppression, diabetes, and prior sepsis after biopsy. Each item will be rated on a 6-point Likert scale, where 1–2 = Low or negligible importance 3–4 = Intermediate importance 5–6 = High importance There will be open-text fields allowing participants to suggest additional risk factors not listed in the first round. Round 2 Participants will receive anonymised summary statistics from Round 1 (median, IQR, distribution). All original and newly suggested items will be re-rated, with the opportunity to revise scores based on group trends. Newly suggested items from round 1 will be presented. Round 3 Only items that did not reach a consensus in Round 2 will be presented. Participants will again rate each item on the 6-point scale, aiming to resolve disagreement. Consensus Definition Consensus in: ≥70% rate 5–6 and <15% rate 1–2 Consensus out: ≥70% rate 1–2 and <15% rate 5–6 No consensus: anything else Data Management and Analysis All data will be processed anonymously. Summary statistics (medians, IQRs, consensus proportions) will be used for analysis. Answers will be stratified according to registered variables such as medical specialty, level of expertise, geographical representation etc. throughout the domains to provide a comprehensive reporting of all studied aspects related to best practice and antibiotic prophylaxis in transperineal biopsy. Free-text data will be coded thematically. Free-text data will be coded thematically. Ethics This study involves no patients and poses no risk. As such, ethics approval is not required under applicable guidelines. Funding The study is not funded but the platform for the Delphi Consensus (Within3) will be provided via an unrestricted grant by Advanz Pharma. Dissemination The final consensus statement will be submitted for publication in high-impact journals. Timeline Month 1: Panel recruitment and item generation Months 2–3: Round 1 Months 3–4: Round 2 Months 4–5: Round 3 Months 5–6: Analysis and manuscript preparation Evidence background for suggested risk factors View this table: View inline View popup Delphi Questionnaire Best Practice and Risk Factors for Antibiotic Prophylaxis in TP Biopsy Procedural Factors 1. To what extent do you consider taking ≥20 biopsy cores a risk factor justifying antibiotic What is your medical speciality? Please select answers (choose all that apply) Urologist Infectious disease specialist Microbiologist/ clinical microbiologist 2. How would you grade your own qualifications/knowledge related to the following: Please grade your level of expertise on a scale of 1-6 (1 means foundational/basic knowledge; 6 indicates expert knowledge) Prostate cancer treatment Prostate cancer diagnostics Prevalence and prevention of hospital acquired urogenital infections Antibiotic treatment of urogenital infections including sepsis Types of microorganisms and rates of resistance among pathogens causing urogenital infections Antimicrobial stewardship 3. What percentage of biopsies in your department are done with the following approach/guidance? Please use the dropdown list to select an approximate percentage (to the nearest 5%) for each biopsy type. The total of all 3 percentages should be as close to 100% as possible. Any additional information can be added to the free-text box below. Once complete, please click the ‘Submit’ button. Transperineal ultrasound-guided biopsies Transrectal ultrasound-guided biopses Transperineal in-bore prostate biopsy 4. What percentage of targeted biopsies in your department are done with the following technique? Please use the dropdown list to select an approximate percentage (to the nearest 5%) for each biopsy type. The total of all 3 percentages should be as close to 100% as possible. Any additional information can be added to the free-text box below. Once complete, please click the ‘Submit’ button. Image fusion technology (MRI and ultrasound) Cognitive guidance (Based on MRI image) 5. How many patients are typically scheduled per biopsy session (working day) in your centre? 0 1-3 4-6 7-9 10-11 12-14 15-16 17-19 20+ 6. What is the average time allocated per TP biopsy procedure in your centre? 0-15 minutes 16-30 minutes 31-45 minutes 46-60 minutes 61-75 minutes 76-90 minutes >91 minutes 7. Is the biopsy performed as an outpatient, a day surgery, or an inpatient procedure? Outpatient Day surgery Inpatient 8. How many and what type of health personnel are typically involved in the operating theatre/outpatient room during a transperineal biopsy, in addition to the urologist who performs the procedure? Please select the number next to each type of health personnel below A second urologist/ urology resident Radiologists Nurses Nurse’s aides Anesthesiologists Anesthesia nurse Other, please specify below 9. Who typically marks the biopsy targets on MRI images? Please select an answer: Radiologist Urologist Both together 10. Is hair removal routinely performed before transperineal prostate biopsy? Yes No 11. If hair removal is routinely performed before transperineal prostate biopsy, by whom is it removed? Patient Nurse N/A (if answered ‘No’ to Question 8) 12. If hair removal is routinely performed before transperineal prostate biopsy, where is it removed? Patient’s home Operating theatre N/A (if answered ‘No’ to Question 8) 13. If hair removal is routinely performed before transperineal prostate biopsy, how is it removed? Razor Clippers Hair removal cream N/A (if answered ‘No’ to Question 8) 14. If hair removal is routinely performed before transperineal prostate biopsy, when is it removed? Before the procedure As part of the procedure N/A (if answered ‘No’ to Question 8) 15. How is skin disinfection of the biopsy field performed? 2% chlorhexidine isopropanol solution Povidone iodine solution Benzoyl peroxide (BPO) gel Other 16. How is disinfectant applied? Sterile gauze Spray Other 17. Who typically administers the anaesthesia? Anaesthesist Urologist Nurse Other 18. What type of anaesthesia is typically used in your centre? Please select answers (choose all that apply) Local Sedation General Spinal 19. Do you routinely administer antibiotic prophylaxis in transperineal biopsy? Please select an answer Yes No In high risk patients only (to be defined in this consensus) 20. What route of antibiotic prophylaxis is typically used in your centre? None Oral Intravenous Intramuscular 21. What type of antibiotics do you use? Please select answers (choose all that apply) 1 st generation cephalosporins (e.g., Cefazoline) 2 nd generation cephalosporins (e.g., Cefuroxime) 3 rd generation cephalosporins (e.g., Ceftriaxone) Fosfomycin Aminoglykosides (e.g., Gentamicin) Aminopenicillins (e.g., Amoxicillin) 22. What is your main rationale for the choice of antibiotic prophylaxis in transperineal prostate biopsy? (Please select all that apply.) To cover skin flora (e.g., Staphylococcus spp., gram-positive cocci) To provide broad-spectrum coverage, including gram-negative organisms To target uropathogens commonly found postbioptic prostatitis To align with recommendations for other clean-contaminated urologic procedures Based on personal experience with post-biopsy infections No specific microbiological rationale — prophylaxis according to routine in-hospital guideline Other (please specify): ___________ 23. Do you routinely obtain a urine culture before transperineal biosy to assess asymtpomatic bacteriuria (ABU)? Please select an answer Yes No 24. In case of ABU, do you administer additional antibiotics? Please select an answer: Yes No 25. If you answered ‘Yes’ to ‘In case of ABU, do you administer additional antibiotics?’ A short treatment course before the procedure Periprocedural prophylaxis only Both preprocedural treatment and periprocedural prophylaxis N/A (answered ‘No’ to the previous question) 26. Are you monitoring the detection rate of prostate cancer with transperineal prostate biopsy? Yes No 27. How many transperineal biopsy procedures or transperineal needle-based prostate treatment procedures have you done/supervised yourself (Approximately)? Please provide an approximate number 28. Have you ever seen infections after transperineal biopsy? Yes No If yes, Please write the type of infection (s) Please write the type of pathogen(s) If your observations have been published, please provide the reference 29. What type of access do you use for TPBx? Please select an answer Template-guided access Single-entry port Other, please specify below 30. Please describe your biopsy sampling methods Please select answers (choose all that apply) Systematic biopsy without targeted biopsy Systematic biopsy with targeted biopsy Targeted biopsy only Targeted biopsy and perilesional sampling 31. How many cores are usually taken in one biopsy procedure for a systematic biopsy only? Please provide the number (or range) for: Critical volume for when extra cores are taken (e.g., 50cc): Number of extra cores per volume unit (e.g., 1 extra core per 10cc): 32. How many cores are usually taken in one biopsy procedure for a systematic biopsy with targeted biopsy? Please provide the number (or range) for Number of cores per target lesion (>PIRADS 3): 33. How many cores are usually taken in one biopsy procedure for a targeted biopsy only? Please provide the number (or range) for: Number of cores per target lesion (>PIRADS 3): Number of cores per exact (> PIRADS 3) anatomic location (e.g., apical bilaterally, posteromedial bilaterally): 34. How many cores are usually taken in one biopsy procedure for a targeted biopsy and perilesional sampling? Please provide the number (or range) for Number of perilesional cores per target (PIRADS 3 or above): 35. In which contamination category will you place transperineal prostate biopsy? Please select an answer: Clean Clean contaminated (Urinary tract) Clean contaminated (Bowel) Contaminated 37. If a urology department monitored the overall rate of infective complications without prophylaxis (including all risk factors), at which level of infective complications would you recommend starting routine antibiotic prophylaxis? (Please tick your lowest acceptance rate only) Please select an answer 1% 2% 3% 4% 5% 10% 15% 20% Patient-Related Factors 38. To what extent do you consider that the risk factors below justify antibiotic prophylaxis in TP biopsy? Please use the dropdown list to rate each risk factor via the following 6-point Likert scale. Any additional information can be added to the free-text box below. Once complete, please click the ‘Submit’ button before progressing to the next question. Likert Scale 1–2 = Low or negligible importance 3–4 = Intermediate importance 5–6 = High importance If you feel you do not have the necessary expertise to answer the questions is this domain, please proceed to Question 3 Please rate the following: Taking ≥20 biopsy cores Performing a repeat biopsy within 6 months Performing a simultaneous endoscopic/urologic procedure Procedure duration >30 minutes Violation of sterility in the surgical field (e.g., poor margins/coverage, iodine prep.) Inexperienced operator Please feel free to elaborate on your response 39. If two or more of the below risk factors are present, would you consider that the risk factors below justify antibiotic prophylaxis in TP biopsy? Taking ≥20 biopsy cores Performing a repeat biopsy within 6 months Performing a simultaneous endoscopic/urologic procedure Procedure duration >30 minutes Violation of sterility in the surgical field (e.g., poor margins/coverage, iodine prep.) Inexperienced operator Please select an answer: Yes No Depends, please elaborate below 40. If you feel you do not have the necessary expertise to answer the questions in this domain, please answer below Please select an answer: I do not have the necessary expertise to answer the questions in this domain I am confident in this domain and have answered the questions 41. To what extent do you consider that the risk factors below justify antibiotic prophylaxis in TP biopsy? Please use the dropdown list to rate each risk factor via the following 6-point Likert scale. Any additional information can be added to the free-text box below. Once complete, please click the ‘Submit’ button before progressing to the next question. Likert Scale 1–2 = Low or negligible importance 3–4 = Intermediate importance 5–6 = High importance If you feel you do not have the necessary expertise to answer the questions is this domain, please proceed to Question 5 View the attached resources below (ECOG and FRAILTY scores) Please rate the following: Diabetes mellitus (poorly regulated or in need of medical treatment) Immunosuppression (e.g., steroids, chemotherapy) prophylaxis in TP biopsy? The presence of an indwelling urinary catheter Recurrent UTIs (≥2/ 6 months or > 3/ 1 year) A history of post-biopsy infection or urosepsis A history of chronic prostatitis / CPPS Hospitalization or other institutionalization within the recent 3 months Antibiotic usage within the recent 3 months Age >75 years ECOG ≥2 Morbid obesity (BMI ≥40) Critical frailty score ≥4 42. If two or more of the below risk factors are present, would you consider that this situation justifies antibiotic prophylaxis in TP biopsy? Diabetes mellitus (poorly regulated or in need of medical treatment) Immunosuppression (e.g., steroids, chemotherapy) prophylaxis in TP biopsy? The presence of an indwelling urinary catheter Recurrent UTIs (≥2/ 6 months or > 3/ 1 year) A history of post-biopsy infection or urosepsis A history of chronic prostatitis / CPPS Hospitalization or other institutionalization within the recent 3 months Antibiotic usage within the recent 3 months Age >75 years ECOG ≥2 Morbid obesity (BMI ≥40) Critical frailty score ≥4 Microbiological Factors 43. Would any of the risk factors below justify pre-biopsy urine culture, rectal swab culture, or perineal skin swab culture? Diabetes mellitus (poorly regulated or in need of medical treatment) Immunosuppression (e.g., steroids, chemotherapy) prophylaxis in TP biopsy? The presence of an indwelling urinary catheter Recurrent UTIs (≥2/ 6 months or > 3/ 1 year) A history of post-biopsy infection or urosepsis A history of chronic prostatitis / CPPS Hospitalization or other institutionalization within the recent 3 months Antibiotic usage within the recent 3 months Age >75 years ECOG ≥2 Morbid obesity (BMI ≥40) Critical frailty score ≥4 44. Which pathogen species will you consider when deciding on an antibiotic prophylaxis regimen in transperineal prostate biopsy? Please select an answer: Gram negative Gram positive Others, please specify below 45. If you feel you do not have the necessary expertise to answer the questions in this domain, please answer below Please select an answer: I do not have the necessary expertise to answer the questions in this domain I am confident in this domain and have answered the questions 46. To what extent do you consider that the risk factors below justify antibiotic prophylaxis in TP biopsy? Please use the dropdown list to rate each risk factor via the following 6-point Likert scale. Any additional information can be added to the free-text box below. Once complete, please click the ‘Submit’ button before progressing to the next question. Likert Scale 1–2 = Low or negligible importance 3–4 = Intermediate importance 5–6 = High importance If you feel you do not have the necessary expertise to answer the questions is this domain, please proceed to Question 4 Please rate the following: Patient is colonized with MDR microorganisms (Any sample) --Select Option -- Isolation of ESBL-producing organisms in patient within recent 6 months (Any sample) A hospital-wide outbreak or clustering of urosepsis cases 47. If two or more of the below risk factors are present, would you consider that the risk factors below justify antibiotic prophylaxis in TP biopsy? Patient is colonized with MDR microorganisms (Any sample) Isolation of ESBL-producing organisms in patient within recent 6 months (Any sample) A hospital-wide outbreak or clustering of urosepsis cases Please select an answer: Yes No Depends 48. Would any of the below risk factors justify pre-biopsy urine culture or rectal swab culture? Patient is colonized with MDR microorganisms (Any sample) Isolation of ESBL-producing organisms in patient within recent 6 months (Any sample) A hospital-wide outbreak or clustering of urosepsis cases Please rate the following: Urine culture Rectal culture 49. If you feel you do not have the necessary expertise to answer the questions in this domain, please answer below I do not have the necessary expertise to answer the questions in this domain I am confident in this domain and have answered the questions Final Remarks 50. Thank you for answering the questions. Please use this space to ask any questions or provide any additional information. Data Availability All data produced in the present study are available upon reasonable request to the authors References 1. ↵ Hu JC , Assel M , Allaf ME , et al. Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted and Systematic Prostate Biopsy to Prevent Infectious Complications: The PREVENT Randomized Trial . Eur Urol . Jan 11 2024 ; doi: 10.1016/j.eururo.2023.12.015 OpenUrl CrossRef PubMed 2. Hu JC , Assel M , Allaf ME , et al. Transperineal vs Transrectal Prostate Biopsy-The PREVENT Randomized Clinical Trial . JAMA Oncol . Sep 19 2024 ; doi: 10.1001/jamaoncol.2024.4000 OpenUrl CrossRef 3. Mian BM , Feustel PJ , Aziz A , et al. Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE-PC Randomized Clinical Trial . J Urol. Feb 2024 ; 211 ( 2 ): 205 – 213 . doi: 10.1097/ju.0000000000003788 OpenUrl CrossRef 4. ↵ Jacewicz M , Günzel K , Rud E , et al. Antibiotic prophylaxis versus no antibiotic prophylaxis in transperineal prostate biopsies (NORAPP): a randomised, open-label, non-inferiority trial . Lancet Infect Dis. Oct 2022 ; 22 ( 10 ): 1465 – 1471 . doi: 10.1016/s1473-3099(22)00373-5 OpenUrl CrossRef 5. ↵ Blaser MJ . Antibiotic use and its consequences for the normal microbiome . Science . 2016 ; 352 ( 6285 ): 544 – 545 . OpenUrl Abstract / FREE Full Text 6. Cai T , Verze P , Brugnolli A , et al. Adherence to European Association of Urology Guidelines on Prophylactic Antibiotics: An Important Step in Antimicrobial Stewardship . Eur Urol. Feb 2016 ; 69 ( 2 ): 276 – 83 . doi: 10.1016/j.eururo.2015.05.010 OpenUrl CrossRef 7. ↵ Llor C , Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem . Therapeutic advances in drug safety . 2014 ; 5 ( 6 ): 229 – 241 . OpenUrl CrossRef PubMed 8. ↵ Johansen TEB , Botto H , Cek M , et al. Critical review of current definitions of urinary tract infections and proposal of an EAU/ESIU classification system . International journal of antimicrobial agents . 2011 ; 38 : 64 – 70 . OpenUrl CrossRef PubMed 9. ↵ Bjerklund Johansen TE , Bahrs C , Bruyere F , et al. Consensus position statement on advancing the classification of patients and tests of cure in studies of antibiotic treatment of complicated urinary tract infections . Lancet Infect Dis . May 13 2025 ; doi: 10.1016/s1473-3099(25)00142-2 OpenUrl CrossRef 10. Ehdaie B , Vertosick E , Spaliviero M , et al. The impact of repeat biopsies on infectious complications in men with prostate cancer on active surveillance . The Journal of urology . 2014 ; 191 ( 3 ): 660 – 664 . OpenUrl CrossRef PubMed 11. Lightner DJ , Wymer K , Sanchez J , Kavoussi L. Best Practice Statement on Urologic Procedures and Antimicrobial Prophylaxis . J Urol. Feb 2020 ; 203 ( 2 ): 351 – 356 . doi: 10.1097/ju.0000000000000509 OpenUrl CrossRef 12. Cheng H , Chen BP , Soleas IM , Ferko NC , Cameron CG , Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review . Surg Infect (Larchmt) . Aug /Sep 2017 ; 18 ( 6 ): 722 – 735 . doi: 10.1089/sur.2017.089 OpenUrl CrossRef PubMed 13. Solomkin J , Gastmeier P , Bischoff P , et al. WHO global guidelines for the prevention of surgical site infection Geneva . Switzerland. Lancet Infect Dis . 2017 ; 17 ( 3 ): 262 – 4 . OpenUrl PubMed 14. Muilwijk J , van den Hof S , Wille JC . Associations between surgical site infection risk and hospital operation volume and surgeon operation volume among hospitals in the Dutch nosocomial infection surveillance network . Infect Control Hosp Epidemiol . May 2007 ; 28 ( 5 ): 557 – 63 . doi: 10.1086/513613 OpenUrl CrossRef PubMed Web of Science 15. Grober ED , Domes T , Fanipour M , Copp JE . Preoperative Hair Removal on the Male Genitalia: Clippers vs. Razors . The Journal of Sexual Medicine . 2013/02/01/ 2013 ; 10 ( 2 ): 589 – 594 . doi: 10.1111/j.1743-6109.2012.02904.x OpenUrl CrossRef PubMed 16. Coccolini F , Improta M , Cicuttin E , et al. Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature . World J Emerg Surg . Jun 10 2021 ; 16 ( 1 ): 33 . doi: 10.1186/s13017-021-00375-y OpenUrl CrossRef PubMed 17. Martin ET , Kaye KS , Knott C , et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis . Infect Control Hosp Epidemiol . Jan 2016 ; 37 ( 1 ): 88 – 99 . doi: 10.1017/ice.2015.249 OpenUrl CrossRef PubMed 18. Sandberg M , Whitman W , Greenberg J , et al. Risk factors for infection and acute urinary retention following transperineal prostate biopsy . Int Urol Nephrol . Mar 2024 ; 56 ( 3 ): 819 – 826 . doi: 10.1007/s11255-023-03854-0 OpenUrl CrossRef PubMed 19. Magill SS , O’Leary E , Janelle SJ , et al. Changes in Prevalence of Health Care-Associated Infections in U.S . Hospitals. N Engl J Med . Nov 1 2018 ; 379 ( 18 ): 1732 – 1744 . doi: 10.1056/NEJMoa1801550 OpenUrl CrossRef 20. Storme O , Tirán Saucedo J , Garcia-Mora A , Dehesa-Dávila M , Naber KG . Risk factors and predisposing conditions for urinary tract infection . Ther Adv Urol. Jan-Dec 2019 ; 11 : 1756287218814382 . doi: 10.1177/1756287218814382 OpenUrl CrossRef 21. Loeb S , Carter HB , Berndt SI , Ricker W , Schaeffer EM . Is repeat prostate biopsy associated with a greater risk of hospitalization? Data from SEER-Medicare . J Urol . Mar 2013 ; 189 ( 3 ): 867 – 70 . doi: 10.1016/j.juro.2012.10.005 OpenUrl CrossRef PubMed 22. Anderson E , Leahy O , Cheng AC , Grummet J. Risk factors for infection following prostate biopsy - a case control study . BMC Infect Dis . Dec 23 2015 ; 15 : 580 . doi: 10.1186/s12879-015-1328-7 OpenUrl CrossRef PubMed 23. Seo Y , Lee G. New Bacterial Infection in the Prostate after Transrectal Prostate Biopsy . J Korean Med Sci. 4/ 2018 ; 33 ( 17 ) 24. Alshubaily AM , Alosaimi AS , Alhothli BI , Althawadi SI , Alghamdi SM . Risk of invasive MDRO infection in MDRO-colonized patients . Infect Control Hosp Epidemiol . Oct 14 2024 : 1 – 5 . doi: 10.1017/ice.2024.156 OpenUrl CrossRef 25. Jensen MLV , Siersma V , Søes LM , Nicolaisdottir D , Bjerrum L , Holzknecht BJ . Prior Antibiotic Use Increases Risk of Urinary Tract Infections Caused by Resistant Escherichia coli among Elderly in Primary Care: A Case-Control Study . Antibiotics (Basel) . Oct 9 2022 ; 11 ( 10 ) doi: 10.3390/antibiotics11101382 OpenUrl CrossRef 26. Ku JH , Tartof SY , Contreras R , et al. Antibiotic Resistance of Urinary Tract Infection Recurrences in a Large Integrated US Healthcare System . The Journal of Infectious Diseases . 2024 ; 230 ( 6 ): e1344 – e1354 . doi: 10.1093/infdis/jiae233 OpenUrl CrossRef PubMed 27. Kaye KS , Schmit K , Pieper C , et al. The effect of increasing age on the risk of surgical site infection . J Infect Dis . Apr 1 2005 ; 191 ( 7 ): 1056 – 62 . doi: 10.1086/428626 OpenUrl CrossRef PubMed Web of Science 28. Martin-Loeches I , Guia MC , Vallecoccia MS , et al. Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study . 29. Tuddenham SA , Gearhart SL , Wright Iii EJ , Handa VL . Frailty and postoperative urinary tract infection . BMC Geriatrics . 2022/10/28 2022 ; 22 ( 1 ): 828 . doi: 10.1186/s12877-022-03461-1 OpenUrl CrossRef PubMed 30. Winfield RD , Reese S , Bochicchio K , Mazuski JE , Bochicchio GV . Obesity and the Risk for Surgical Site Infection in Abdominal Surgery . Am Surg . Apr 2016 ; 82 ( 4 ): 331 – 6 . OpenUrl PubMed 31. Meijs AP , Koek MBG , Vos MC , Geerlings SE , Vogely HC , de Greeff SC . The effect of body mass index on the risk of surgical site infection . Infect Control Hosp Epidemiol . Sep 2019 ; 40 ( 9 ): 991 – 996 . doi: 10.1017/ice.2019.165 OpenUrl CrossRef PubMed 32. Mehdorn M , Kolbe-Busch S , Lippmann N , et al. Rectal colonization is predictive for surgical site infections with multidrug-resistant bacteria in abdominal surgery . Langenbecks Arch Surg . Jun 10 2023 ; 408 ( 1 ): 230 . doi: 10.1007/s00423-023-02961-x OpenUrl CrossRef PubMed 33. Bonkat G , Bartoletti R , Bruyère F , et al. EAU Guidelines on Urological Infections . 2025 . https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urological-infections-2025.pdf 34. Organization WH . Global guidelines on the prevention of surgical site infection . Global guidelines on the prevention of surgical site infection . 2016 . 35. Sood G , Perl TM . Outbreaks in Health Care Settings . Infect Dis Clin North Am . Sep 2016 ; 30 ( 3 ): 661 – 87 . doi: 10.1016/j.idc.2016.04.003 OpenUrl CrossRef PubMed View the discussion thread. Back to top Previous Next Posted July 17, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following International Delphi Consensus on Risk Factors Justifying Antibiotic Prophylaxis in Transperineal Prostate Biopsy Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share International Delphi Consensus on Risk Factors Justifying Antibiotic Prophylaxis in Transperineal Prostate Biopsy FP Stangl , F Wagenlehner , J Kranz , TE Bjerklund Johansen medRxiv 2025.07.15.25331517; doi: https://doi.org/10.1101/2025.07.15.25331517 Share This Article: Copy Citation Tools International Delphi Consensus on Risk Factors Justifying Antibiotic Prophylaxis in Transperineal Prostate Biopsy FP Stangl , F Wagenlehner , J Kranz , TE Bjerklund Johansen medRxiv 2025.07.15.25331517; doi: https://doi.org/10.1101/2025.07.15.25331517 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Urology Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (297) Cardiovascular Medicine (4421) Dentistry and Oral Medicine (443) Dermatology (381) Emergency Medicine (606) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1507) Epidemiology (15212) Forensic Medicine (30) Gastroenterology (1121) Genetic and Genomic Medicine (6581) Geriatric Medicine (667) Health Economics (996) Health Informatics (4520) Health Policy (1366) Health Systems and Quality Improvement (1611) Hematology (539) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15906) Intensive Care and Critical Care Medicine (1103) Medical Education (620) Medical Ethics (144) Nephrology (667) Neurology (6580) Nursing (345) Nutrition (998) Obstetrics and Gynecology (1141) Occupational and Environmental Health (956) Oncology (3324) Ophthalmology (970) Orthopedics (369) Otolaryngology (420) Pain Medicine (435) Palliative Medicine (129) Pathology (663) Pediatrics (1689) Pharmacology and Therapeutics (691) Primary Care Research (710) Psychiatry and Clinical Psychology (5431) Public and Global Health (9212) Radiology and Imaging (2193) Rehabilitation Medicine and Physical Therapy (1368) Respiratory Medicine (1194) Rheumatology (593) Sexual and Reproductive Health (709) Sports Medicine (529) Surgery (709) Toxicology (99) Transplantation (288) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9ff160ecbc19c13d',t:'MTc3OTM0MzQxMw=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();