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Antibiotic Prophylaxis for Transrectal Prostate Biopsy
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Do Gyeong Lim, Seung Il Jung
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Urogenit Tract Infect 2026;21(2):47-55. Published online August 31, 2026
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DOI: https://doi.org/10.14777/uti.2652012.006
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 Abstract
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- Transrectal prostate biopsy (TRPB) is widely used for the diagnosis of prostate cancer but carries a clinically meaningful risk of infectious complications due to inoculation and translocation of rectal flora into the urinary tract and bloodstream. Antibiotic prophylaxis remains central to preventing febrile urinary tract infection and sepsis; however, increasing antimicrobial resistance—particularly fluoroquinolone-resistant Enterobacterales—has reduced the reliability of conventional empirical regimens in many regions. In this narrative review, we searched PubMed/MEDLINE, Embase, and Scopus for relevant literature published through February 2026 and synthesized current guideline positions and selected clinical evidence on prophylactic regimens, resistance-adapted regimen selection, and adjunctive measures for TRPB. Cumulative evidence indicates that the efficacy of fluoroquinolone monotherapy has significantly declined in regions with high-resistance prevalence. Alternative or augmented strategies (e.g., cephalosporin- or fosfomycin-based approaches) may reduce infectious complications in selected settings, although their performance appears context-dependent and may be accompanied by shifts in pathogen distribution. Rectal swab-guided targeted prophylaxis can individualize antibiotic selection; however, its effectiveness varies across studies because of methodological heterogeneity and imperfect prediction of clinical outcomes. Technique-based prevention, most notably transperineal biopsy, may reduce infectious risk while decreasing reliance on broad-spectrum prophylaxis. Taken together, infection prevention after prostate biopsy should be individualized according to local susceptibility patterns and patient-level risk while integrating antimicrobial stewardship and selecting adjunctive or technique-based measures when feasible.
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Impact of Antibiotics on the Efficacy of Immune Checkpoint Inhibitors in Metastatic Urothelial Carcinoma
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Do Gyeong Lim, Ho Yeon Lee, Ho Seok Chung, Eu Chang Hwang, Seung Il Jung, Dong Deuk Kwon
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Urogenit Tract Infect 2023;18(3):75-81. Published online December 31, 2023
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DOI: https://doi.org/10.14777/uti.2023.18.3.75
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Abstract
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- Purpose: Emerging evidence has suggested that prior or concurrent antibiotic (ATB) use may be associated with a poor response to immune checkpoint inhibitors (ICIs) in patients with some solid tumors. This study examined the effects of ATB use on the oncological outcomes of patients receiving ICIs for mUC.
Materials and Methods: Patients receiving ICIs for mUC between 2018 and 2020 were assessed retrospectively. Those with over three cycles of atezolizumab or pembrolizumab were included. ATB use, defined as ≥ three days within 60 days before or three months after ICI administration, was compared between groups for oncological outcomes.
Results: Thirty-one patients were examined. The ATB-use and no-ATB-use groups consisted of 15 (48.4%) and 16 patients (51.6%), respectively. The ATB-use group showed a lower disease control rate (56.3% vs. 13.3%, p=0.023) than the no-ATB-use group. The objective response rate in the ATB-use group was lower than the no-ATB-use group, but the difference was statistically insignificant (43.7% vs. 13.3%, p=0.113). The ATB-use group had shorter progression-free survival (median three vs. six months, log-rank p=0.045) and shorter overall survival (median three vs. 14 months, log-rank p=0.023) than the no-ATB-use group. The most commonly used antibiotics were fluoroquinolones (46.7%), cephalosporins (40.0%), non-cephalosporin beta-lactams (6.7%), and nitrofurantoin (6.7%).
Conclusions: ATB may be associated with poorer oncological outcomes in patients with mUC who received ICI therapy. Hence, further research will be needed to understand the relationship between the modulation of ATB-related dysbiosis and gut microbiota composition with the oncological outcomes in patients with mUC.
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