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A Prospective Randomized Trial of Povidone-Iodine Prophylactic Cleansing of the Rectum Before Transrectal Ultrasound Guided Prostate Biopsy

2012; Lippincott Williams & Wilkins; Volume: 189; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2012.09.121

1527-3792

Zeid AbuGhosh, Joseph Margolick, S. Larry Goldenberg, Stephen A. Taylor, Kourosh Afshar, Robert H. Bell, Dirk Lange, William Bowie, Diane Roscoe, Lindsay Machan, Peter C. Black,

Urinary Tract Infections Management

No AccessJournal of UrologyAdult Urology1 Apr 2013A Prospective Randomized Trial of Povidone-Iodine Prophylactic Cleansing of the Rectum Before Transrectal Ultrasound Guided Prostate Biopsy Zeid AbuGhosh, Joseph Margolick, S. Larry Goldenberg, Stephen A. Taylor, Kourosh Afshar, Robert Bell, Dirk Lange, William R. Bowie, Diane Roscoe, Lindsay Machan, and Peter C. Black Zeid AbuGhoshZeid AbuGhosh Nothing to disclose. More articles by this author , Joseph MargolickJoseph Margolick Nothing to disclose. More articles by this author , S. Larry GoldenbergS. Larry Goldenberg Financial interest and/or other relationship with Sanofi and Abbott. More articles by this author , Stephen A. TaylorStephen A. Taylor Nothing to disclose. More articles by this author , Kourosh AfsharKourosh Afshar Nothing to disclose. More articles by this author , Robert BellRobert Bell Nothing to disclose. More articles by this author , Dirk LangeDirk Lange Nothing to disclose. More articles by this author , William R. BowieWilliam R. Bowie Nothing to disclose. More articles by this author , Diane RoscoeDiane Roscoe Nothing to disclose. More articles by this author , Lindsay MachanLindsay Machan Financial interest and/or other relationship with Ultrasonix Inc., Cook Inc. and Boston Scientific Corp. More articles by this author , and Peter C. BlackPeter C. Black Nothing to disclose. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.09.121AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Transrectal ultrasound guided prostate biopsy can lead to urinary tract infections in 3% to 11% and sepsis in 0.1% to 5% of patients. We investigated the efficacy of rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy to reduce infectious complications. Materials and Methods: Between 2009 and 2011, 865 men were prospectively randomized to rectal cleansing (421) or no cleansing (444) before transrectal ultrasound guided prostate biopsy. Patients received ciprofloxacin prophylaxis and rectal swab cultures were obtained before transrectal ultrasound guided prostate biopsy. Patients completed a telephone interview 7 days after undergoing the biopsy. The primary end point was the rate of infectious complications, a composite end point of 1 or more of 1) fever greater than 38.0C, 2) urinary tract infection or 3) sepsis (standardized definition). Chi-square significance testing was performed for differences between groups and a multivariate analysis was performed to assess risk factors for infectious complications. Results: Infectious complications were observed in 31 (3.5%) patients, including 11 (2.6%) treated and 20 (4.5%) control patients (p = 0.15). Sepsis was observed in 4 (1.0%) treated and 7 (1.6%) control patients (p = 0.55). On multivariate analysis resistance to ciprofloxacin in the rectal swab culture (p = 0.002) and a history of taking ciprofloxacin in the 3 months preceding transrectal ultrasound guided prostate biopsy (p = 0.009) predicted infectious complications. Conclusions: Rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy was safe, but the 42% relative risk reduction of infectious complications was not statistically significant. Patients who have received ciprofloxacin within 3 months of transrectal ultrasound guided prostate biopsy should be considered for alternate prophylaxis or possibly a delay of biopsy beyond 3 months. References 1 : Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol2010; 183: 963. Link, Google Scholar 2 : Complications following prostate needle biopsy requiring hospital admission or emergency department visits–experience from 1000 consecutive cases. BJU Int2012; 110: 369. Google Scholar 3 : Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis?. Eur Urol2012; 62: 453. Google Scholar 4 : The incidence of fluoroquinolone resistant infections after prostate biopsy–are fluoroquinolones still effective prophylaxis?. J Urol2008; 179: 952. Link, Google Scholar 5 : Bacterial sepsis after prostate biopsy–a new perspective. Urology2009; 74: 1200. Google Scholar 6 : Is it possible to predict sepsis, the most serious complication in prostate biopsy?. Urol Int2010; 84: 395. Google Scholar 7 : Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol2012; 61: 1110. Google Scholar 8 : Simple use of the suppository type povidone-iodine can prevent infectious complications in transrectal ultrasound-guided prostate biopsy. Adv Urol2009; : 750598. Google Scholar 9 : Povidone-iodine vs sodium hypochlorite enema for mechanical preparation before elective open colonic or rectal resection with primary anastomosis: a multicenter randomized controlled trial. Arch Surg2006; 141: 1168. Google Scholar 10 : Colonic sterilization for natural orifice translumenal endoscopic surgery (NOTES) procedures: a comparison of two decontamination protocols. Surg Endosc2009; 23: 1854. Google Scholar 11 : Reduction in bacteremia rates after rectum sterilization before transrectal, ultrasound-guided prostate biopsy: a randomized controlled trial. J Med Assoc Thai2009; 92: 1621. Google Scholar 12 American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med1992; 20: 864. Google Scholar 13 : Antibiotic prophylaxis for transrectal prostate biopsy. Cochrane Database Syst Rev2011; 5. CD006576. Google Scholar 14 : A prospective randomized trial of 1-day versus 3-day antibiotic prophylaxis for transrectal ultrasound guided prostate biopsy. Can J Urol2004; 11: 2216. Google Scholar 15 : Modified bowel preparation to reduce infection after prostate biopsy. Chang Gung Med J2006; 29: 395. Google Scholar 16 : Efficacy of prophylactic antimicrobial regimens in preventing infectious complications after transrectal biopsy of the prostate. Int Urol Nephrol1990; 22: 257. Google Scholar 17 : Bacteremia and bacteriuria after transrectal prostatic biopsy. Urology1981; 18: 145. Google Scholar 18 : Prevention of pain and infective complications after transrectal prostate biopsy: a prospective study. Int Urol Nephrol2006; 38: 45. Google Scholar 19 : Cost-effectiveness of standard vs intensive antibiotic regimens for transrectal ultrasonography (TRUS)-guided prostate biopsy prophylaxis. BJU Int2012; 110: E86. Google Scholar 20 : Infection after transrectal ultrasonography-guided prostate biopsy: increased relative risks after recent international travel or antibiotic use. BJU Int2012; 109: 1781. Google Scholar 21 : Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms. Urology2011; 78: 250. Google Scholar 22 : Rising incidence of acute prostatitis following prostate biopsy: fluoroquinolone resistance and exposure is a significant risk factor. Urology2011; 78: 511. Google Scholar 23 : Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy-should we reassess our practices for antibiotic prophylaxis?. Clin Microbiol Infect2012; 18: 575. Google Scholar 24 : Rectal cultures before transrectal ultrasound-guided prostate biopsy reduce post-prostatic biopsy infection rates. Urology2012; 79: 556. Google Scholar 25 : Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol2012; 187: 1275. Link, Google Scholar 26 : Sepsis due to fluoroquinolone-resistant Escherichia coli after transrectal ultrasound-guided prostate needle biopsy. Urology2009; 74: 332. Google Scholar Department of Urologic Sciences (ZA, JM, SLG, SAT, KA, DL, PCB), Department of Medicine (WRB), Department of Pathology and Laboratory Medicine (DR) and Department of Radiology (LM), University of British Columbia, Vancouver, British Columbia, Canada© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPontes-Junior J and Magalhães Freire T (2022) Effectiveness of Intrarectal Povidone-iodine Cleansing Plus Formalin Disinfection of the Needle Tip in Decreasing Infectious Complications After Transrectal Prostate Biopsy: A Randomized Controlled Trial. Reply.Journal of Urology, VOL. 209, NO. 1, (74-75), Online publication date: 1-Jan-2023.Pontes-Junior J, Freire T, Pugliesi F, de Moura Costa F, de Souza V, Galucci F, Albertini A, Couto A, Murta C, Guglielmetti G, Nahas W, Andriolo Junior A, Neto A and de Almeida Claro J (2022) Effectiveness of Intrarectal Povidone-iodine Cleansing Plus Formalin Disinfection of the Needle Tip in Decreasing Infectious Complications After Transrectal Prostate Biopsy: A Randomized Controlled TrialJournal of Urology, VOL. 208, NO. 6, (1194-1202), Online publication date: 1-Dec-2022.Papagiannopoulos D, Abern M, Wilson N, O’Block N, Raff L, Coogan C and Latchamsetty K (2017) Predictors of Infectious Complications after Targeted Prophylaxis for Prostate Needle BiopsyJournal of Urology, VOL. 199, NO. 1, (155-160), Online publication date: 1-Jan-2018.Liss M, Taylor S, Batura D, Steensels D, Chayakulkeeree M, Soenens C, Rao G, Dash A, Park S, Patel N, Woo J, McDonald M, Nseyo U, Banapour P, Unterberg S, Ahlering T, Van Poppel H, Sakamoto K, Fierer J and Black P (2014) Fluoroquinolone Resistant Rectal Colonization Predicts Risk of Infectious Complications after Transrectal Prostate BiopsyJournal of Urology, VOL. 192, NO. 6, (1673-1678), Online publication date: 1-Dec-2014.Issa M, Al-Qassab U, Hall J, Ritenour C, Petros J and Sullivan J (2013) Formalin Disinfection of Biopsy Needle Minimizes the Risk of Sepsis Following Prostate BiopsyJournal of Urology, VOL. 190, NO. 5, (1769-1775), Online publication date: 1-Nov-2013.Steers W (2013) This Month in Adult UrologyJournal of Urology, VOL. 189, NO. 4, (1181-1182), Online publication date: 1-Apr-2013. Volume 189Issue 4April 2013Page: 1326-1331 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsbiopsyurinary tract infectionsprostatesepsisAcknowledgmentsThe technicians in the Radiology and Microbiology Departments, especially Gary Franco and Matilda Nasariya, provided assistance; the team of radiologists (C. Zwirewich, A. Harris, J. Buckley and S. Chang) conducted the biopsies; and the urologists enrolled their patients in the study (M. Gleave, A. So, M. McLoughlin, B. Chew, R. Paterson, M. Nigro, H. Fenster and C. Nguan).MetricsAuthor Information Zeid AbuGhosh Nothing to disclose. More articles by this author Joseph Margolick Nothing to disclose. More articles by this author S. Larry Goldenberg Financial interest and/or other relationship with Sanofi and Abbott. More articles by this author Stephen A. Taylor Nothing to disclose. More articles by this author Kourosh Afshar Nothing to disclose. More articles by this author Robert Bell Nothing to disclose. More articles by this author Dirk Lange Nothing to disclose. More articles by this author William R. Bowie Nothing to disclose. More articles by this author Diane Roscoe Nothing to disclose. More articles by this author Lindsay Machan Financial interest and/or other relationship with Ultrasonix Inc., Cook Inc. and Boston Scientific Corp. More articles by this author Peter C. Black Nothing to disclose. More articles by this author Expand All Advertisement PDF downloadLoading ...