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

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

doi:10.1016/j.juro.2012.09.121

Cited by 92 publications

(86 citation statements)

References 22 publications

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“…1,2,27 The rates at our institution are closer to the upper limit of the global range, with 83% of septic episodes and 66.6% of urinary tract infections caused by ciprofloxacin-resistant microbes. Carigan and colleagues found that the incidence of post-biopsy sepsis increased from 0.71% in 2002-2003 to 2.15% in 2010-2011.…”

Section: Discussionmentioning

confidence: 66%

“…Currently, it is estimated that about 1 million TRUS-PB are performed on annually in North America. 3,27 The increasing incidence of hospitalization due to post-biopsy complications are a barrier to prostate cancer detection and active surveillance of patients with low-risk prostate cancer. 27 The microbes responsible for most infectious complications at our centre reveal high resistance rates to the antibiotics recommended by North American Clinical Practice Guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…Adjunctive measures with pre-biopsy rectal swabs, enemas, and povidone iodine rectal cleanse have shown conflicting and clinically insignificant results. 14,27,29 Currently, there are no concrete mitigating strategies to reduce the risk of post-TRUS-PB associated infections. Furthermore, there are no clinical practice guidelines on the management of post-biopsy infectious complications.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

Rudzinski

Kawakami²

2014

CUAJ

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Introduction:We have seen an increased risk of infectious complications following transrectal ultrasound-guided prostate biopsy (TRUS-PB). Fluoroquinolone (FQ) antibiotics are common for prophylaxis prior to TRUS-PB. We evaluate whether increasing FQ resistance correlates with increased incidence of post-biopsy infectious complications at our institution. Methods: We conducted a retrospective chart and electronic health record review on 927 patients who underwent TRUS-PB between January and July of 2012 in Calgary, Alberta, Canada. We prospectively collected the following variables: age, pre-biopsy prostatespecific antigen, and date of biopsy. We documented presentation to an emergency department within 30 days of TRUS-PB for infectious and non-infectious complications. Results: Of the 927 patients, 58 patients (6.3%) were admitted to the emergency department due to post-TRUS-PB complications within 30 days post-biopsy. The most common infectious complications were sepsis in 21 patients (2.2%), followed by urinary tract infection (UTI) in 9 (0.9%), and prostatitis in 4 (0.4%). We found that 83% of the septic episodes and 66.6% of the UTIs were attributed to ciprofloxacin resistant Escherichia coli (E. coli). The incidence of non-infectious complications was as follows: urinary retention in 12 (1.2%), hematuria in 9 (0.9%), and rectal bleeding in 8 (0.8%). Conclusion: Our results suggest an increased incidence of infectious complications caused by FQ resistant organisms following TRUS-PB. This finding could be attributed to increasing community resistance to ciprofloxacin. The current antimicrobial prophylactic regimen needs to be re-evaluated, and a novel approach may need to be considered.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

Rudzinski

Kawakami²

2014

CUAJ

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“…Fluoroquinolone resistant organisms have been identified in 10-30% of patients undergoing rectal swab culture before PB 47,[49][50][51][52] , although rates of clinical infectious complications are lower at approximately 1-17.5% 7,45,46,48,[53][54][55][56][57] . Most infections are self-limiting and can be managed in the outpatient setting 7,45 .…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

Complications After Systematic, Random, and Image-guided Prostate Biopsy

et al. 2017

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Evidence Synthesis: The most frequent complication after PB is minor and self-limiting bleeding (hematuria and hematospermia), irrespective of the biopsy approach. Occurrence of rectal bleeding was comparable among traditional TRUS-guided and image-guided PB. Almost 25% of patients experience lower urinary tract symptoms, but only a few have urinary retention, with higher rates after transperineal approach. Temporary erectile dysfunction is not negligible, with a return to baseline after 1-6 months. The incidence of infective complications is being increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, irrespective of biopsy technique. Conclusions:Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. Still, a careful appraisal of 3 patient's general health status, risk factors and likelihood of antimicrobial resistance should be done before scheduling a PB. Patient Summary:In this paper we reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, seldom represent a problem for the patient. The most troublesome complications are infections. In order to minimize this risk, a careful evaluation of patient's medical condition must be done before biopsy.4

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“…However, the role of adjunct measures in prevention of post biopsy infections remains controversial [23,24]. Zani et al [23] reported no significant differences in total infectious complication rates between "antibiotic" and "antibiotic+enema" groups, and in a prospective randomized trial, rectal cleansing with povidoneiodine before transrectal ultrasound guided prostate biopsy did not result in a statistically significant reduction in the risk of infectious complications [25]. However, contradictory findings were also reported.…”

Section: Discussionmentioning

confidence: 99%

Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study

Hwang

Jung

et al. 2016

Urogenit Tract Infect

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Purpose: Recent studies have highlighted an increasing trend of infectious complications due to fluoroquinolone-resistant organisms among men undergoing transrectal prostate biopsy. This study evaluated the current incidence of infective complications after trans-rectal prostate biopsy for identification of risk factors in Korean men who received fluoroquinolone prophylaxis. Materials and Methods: A prospective, multicenter study was conducted in Korea from January to December 2015. Prostate biopsies performed with fluoroquinolone prophylaxis during 3 months in each center were included. A pre-biopsy questionnaire was used for identification of patient characteristics. Clinical variables including underlying disease, antibiotic prophylaxis, enema, povidoneiodine cleansing of the rectum, and infectious complications were evaluated. The primary outcome was the post-biopsy infection rate after fluoroquinolone prophylaxis. Univariable and multivariable analyses were used for identification of risk factors for infectious complications. Results: The study included 827 patients, of whom 93 patients (11.2%) reported receiving antibiotics in the previous 6 months and 2.5% had a history of prostatitis. The infectious complication rate was 2.2%. Post-biopsy sepsis was reported in 2 patients (0.2%). In multivariable analysis predictors of post-biopsy sepsis included person performing biopsy (adjusted odds ratio [OR], 4.05; 95% confidence interval [CI], 1.31-12.5; p=0.015) and operation history within 6 months (adjusted OR, 5.65; 95% CI, 1.74-18.2; p=0.004). Conclusions:The post-prostate biopsy infectious complication rate in this study was 2.2%. Person performing biopsy (non-urologists) and recent operation history were independent risk factors for infectious complications after trans-rectal prostate biopsy. . Fluoroquinolones (FQs) are particularly useful in this setting owing to their broad spectrum of activity against intestinal flora as well as their high prostatic tissue levels after oral administration [2,3]. KeywordsDespite antibiotic prophylaxis, several recent studies have reported an increased rate of infective complications following transrectal prostate biopsy in both North America and Europe [4][5][6][7][8]. A recent review of the literature found that up to 6.3% of patients required hospitalization due to post-biopsy complications [4]. This has led to increased use of multiple broad-spectrum antibiotics for prophylaxis; however, this practice may accelerate the development of resistant bacteria [9,10]. The most common pathogen implicated in post-transrectal prostate biopsy sepsis is Escherichia coli, accounting for approximately 75-90% of infectious complications. Antimicrobial-resistant E. coli has been increasingly reported in post-biopsy sepsis over the past decade [8]. The link between prior FQ exposure, colonization with fluoroquinolone-resistant (FQ-R) E. coli, and subsequent post-biopsy infection with FQ-R E. coli was also recently demonstrated [11]. The risk of post-biopsy infection is increased by 7-f...

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

Cited by 92 publications

References 22 publications

Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: A retrospective population-based analysis

Complications After Systematic, Random, and Image-guided Prostate Biopsy

Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study

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