Infectious complications after transrectal prostate biopsy in Algeria: A prospective study in a high-resistance setting.

BACKGROUND: The aim of this study was to assess infectious outcomes and safety of fosfomycin trometamol compared with ciprofloxacin for the prevention of infectious complications following transrectal ultrasound-guided prostate biopsy (TRPB) in a local setting characterized by high fluoroquinolone resistance. MATERIAL AND METHODS: This prospective single-center cohort study included 423 consecutive patients undergoing TRPB between February 2023 and December 2025. An initial comparative phase involved 200 patients receiving either ciprofloxacin (n=83) or fosfomycin trometamol (n=117). Fosfomycin was subsequently adopted as the standard prophylactic regimen in an additional 223 patients. Infectious complications occurring within 30 days were recorded. A univariate analysis was performed to explore factors associated with infectious complications. RESULTS: The overall rate of infectious complications was 8.3% (35/423), mainly transient isolated fever (5.2%). Five patients (1.2%) required hospitalization for acute prostatitis. No statistically significant association with infectious complications was observed in the univariate analysis. In the initial comparative phase, no significant difference was observed between ciprofloxacin and fosfomycin regarding infectious outcomes. CONCLUSIONS: In a context of high fluoroquinolone resistance, single-dose fosfomycin trometamol may represent a pragmatic prophylactic option, although comparative efficacy cannot be concluded from the present design. LEVEL OF EVIDENCE: Level 2.