Prophylactic Antibiotic Use in Transperineal Ultrasound-Guided Prostate Biopsy Under Local Anesthesia: A Retrospective Observational Study.

AIM: Transperineal prostate biopsy under local anesthesia (LATP) carries a low risk of infection, yet prophylactic antibiotics remain commonly used. This study evaluated infection outcomes with and without antibiotic use during LATP.  Methods: We conducted a retrospective analysis of 186 men undergoing LATP between February 2022 and June 2025 under the care of a single urologist. Patients either received a single prophylactic antibiotic dose (Group 1, n = 91) or no antibiotics (Group 2, n = 95). The primary outcome was urinary tract infection (UTI) within 30 days post-biopsy; secondary outcomes included hospital admissions for infection. RESULTS: Baseline characteristics were similar between groups. The incidence of post-biopsy UTI was low and did not differ significantly between patients who received antibiotics and those who did not. No cases of sepsis occurred. Hospital admissions for infection-related complications were rare in both groups. A significant association was observed between smoking history and risk of UTI (p < 0.05), whereas other comorbidities showed no association. CONCLUSIONS: In this cohort, the omission of prophylactic antibiotics during LATP prostate biopsy was not associated with an increased risk of infection. These findings support the safety of a no-antibiotic approach and highlight smoking as a potential risk factor for post-biopsy UTI. Broader adoption of selective antibiotic protocols may contribute to improved antimicrobial stewardship without compromising patient safety.