{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T11:29:37Z","timestamp":1771932577584,"version":"3.50.1"},"reference-count":17,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T00:00:00Z","timestamp":1771027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Faculty of Medicine of the Lithuanian University of Health Sciences"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Transrectal ultrasound-guided prostate biopsy remains the gold standard in diagnosing prostate cancer, but is associated with infectious and non-infectious complications. Increasing fluoroquinolone resistance and regulatory restrictions have prompted evaluation of alternative prophylactic strategies, including fluoroquinolone-sparing agents and targeted prophylaxis. This study compared ciprofloxacin and fosfomycin as empirical prophylactic agents, focusing on microbiological concordance, clinical outcomes, and patient-reported outcomes. Methods: In this prospective observational study, 265 men undergoing transrectal ultrasound-guided prostate biopsy received empirical antibiotic prophylaxis with either ciprofloxacin (n = 146) or fosfomycin trometamol (n = 119). Rectal swabs were obtained prior to biopsy, and antimicrobial susceptibility was analyzed post hoc. Infectious and non-infectious complications were recorded. Lower urinary tract symptoms (IPSS), erectile function (IIEF-5), and patient-reported quality of life were assessed before and after biopsy. Results: Microbiological concordance between administered prophylaxis and rectal flora susceptibility was higher in the ciprofloxacin group than in the fosfomycin group (80.1% vs. 65.0%, p = 0.007), while resistance rates were similar (10.9% vs. 10.2%). Post-biopsy fever occurred in 5.3% of patients, and hospitalization was required in 3.1%, with no significant differences between prophylaxis groups. IPSS increased significantly after biopsy (p &lt; 0.001), while IIEF-5 scores remained unchanged. Patients with microbiological concordance reported significantly better post-biopsy quality of life (p = 0.006). Conclusions: Ciprofloxacin and fosfomycin showed similar safety profiles as empirical prophylaxis before transrectal prostate biopsy. Although ciprofloxacin achieved higher microbiological concordance, fosfomycin remains a viable alternative. The link between microbial concordance and improved patient-reported quality of life underscores the importance of targeted prophylaxis and supports antimicrobial stewardship in prostate cancer diagnostics.<\/jats:p>","DOI":"10.3390\/medsci14010091","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T09:22:46Z","timestamp":1771320166000},"page":"91","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ciprofloxacin Versus Fosfomycin for Empirical Prophylaxis Before Transrectal Prostate Biopsy: Clinical, Microbiological, and Patient-Reported Outcomes from a Prospective Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2214-2670","authenticated-orcid":false,"given":"Edgaras","family":"Burzinskis","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6745-4347","authenticated-orcid":false,"given":"Ieva","family":"Janulaityte","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7509-0897","authenticated-orcid":false,"given":"Guoda","family":"Burzinskiene","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darijus","family":"Skaudickas","sequence":"additional","affiliation":[{"name":"Department of Urology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albinas","family":"Naudziunas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astra","family":"Vitkauskiene","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,14]]},"reference":[{"key":"ref_1","unstructured":"European Cancer Organization, and European Commission (2026, January 10). 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Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.urology.2016.12.011","article-title":"Prostate biopsy-related infection: Prevention strategies","volume":"104","author":"Roberts","year":"2017","journal-title":"Urology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.euros.2025.08.007","article-title":"Rectal swab\u2013based targeted prophylactic antibiotics reduce infectious complications after transrectal prostate biopsy: A systematic review and meta-analysis of randomized controlled trials","volume":"80","author":"Tsuboi","year":"2025","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.eururo.2019.06.011","article-title":"Fluoroquinolone restrictions and implications for urology","volume":"76","author":"Bonkat","year":"2019","journal-title":"Eur. Urol."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/1\/91\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:49:52Z","timestamp":1771930192000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/1\/91"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,14]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medsci14010091"],"URL":"https:\/\/doi.org\/10.3390\/medsci14010091","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,14]]}}}