Adequate rectal preparation reduces hospital admission for urosepsis after transrectal ultrasound - guided prostate biopsy

Abstract

Objectives: Previous studies have compared infectious outcomes on the basis of whether rectal preparation was performed; however, they failed to evaluate the quality of each rectal preparation, which may have led to confounding results. This study aimed to compare hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy between patients with adequate and traditional rectal preparations. Materials and Methods: Between January 2011 and December 2016, a total of 510 patients who underwent transrectal ultrasound - guided prostate biopsy at our institutions and were orally administered prophylactic antibiotics (levofloxacin) were included. Two rectal preparations were performed: (1) adequate rectal preparation confirmed by digital rectal examination and transrectal ultrasound (Group A, n = 310) and (2) traditional rectal preparation (Group B, n = 200). All patient characteristics were recorded. A logistic regression model was used to assess the effects of the two different rectal preparations on urosepsis, adjusted by patient characteristics. Results: There were a total of three and nine hospitalizations for urosepsis in Groups A and B, respectively. Differences in the demographic data between the two groups were insignificant. Logistic regression showed that adequate rectal preparation before biopsy significantly decreased the risk for urosepsis after biopsy (adjusted odds ratio: 0.2; 95% confidence interval: 0.05 – 0.78; P = 0.021). Conclusions: Adequate rectal preparation could significantly reduce hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy. The quality of rectal preparation should be evaluated before biopsy. If adequate rectal preparation is not achieved, postponing the biopsy and adjusting the rectal preparation regimen are suggested.

Association of Warmer Weather and Infectious Complications Following Transrectal Ultrasound-Guided Prostate Biopsy

“…Alternatively, more concentrated urine may increase the likelihood of developing an infection [ 18 ]. In addition to the causes of bacterial development in other diseases, which may be transmitted directly by direct contact or acquired from contaminated environments, such as food or water, the bacteria causing infections after TRUS-Bx may have been seeded into the prostate, bladder, and/or bloodstream by the hollow-core biopsy needle traversing the rectum into the prostate and/or bladder during TRUS-Bx [ 29 ]. Once the bacteria are introduced into the body, the infection may develop depending mostly on the host defense, bacterial flora, and urination.…”

Nonantibiotic strategies to decrease the postbiopsy hospitalization rates because of infectious complications after transrectal prostate biopsy

“…The reason for PBIC is the transmission of bacteria belonging to the Enterobacteriaceae family, known to be pathogenic microorganisms found in the colon and rectum, from the biopsy needle to the prostate or the bloodstream 2 . To reduce the bacterial load of rectum, various methods, such as oral laxatives, enemas, and rectal preparation with a povidone‐iodine (PI) solution or gel were used 3,4 . Additionally, during the biopsy procedure, contaminated biopsy needles were disinfected with different antiseptic solutions to achieve the same goal 5–7 …”