A Systematic Review and Meta-Analysis of Methods Used to Reduce Infectious Complications Following Transrectal Prostate Biopsy

Jazayeri, Seyed Behzad; Kumar, J.; Nguyen, Sabine; Kuntz, Gretchen; Alam, Muhammad Umar; Tanneru, Karthik; Bazargani, Soroush; Costa, Joseph; Bandyk, Mark; Ganapathi, Hariharan Palayapalayam; Marino, Robert; Koochekpour, Shahriar; Balaji, K.C.

doi:10.1016/j.urology.2020.06.005

Cited by 4 publications

(4 citation statements)

References 38 publications

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“…Previous studies have confirmed the potential of oral prophylaxis with antibiotic agents as an anti-infective treatment for periodontal diseases [ 242 , 243 ]. However, their anti-inflammatory effect has not been reported yet.…”

Section: Resultsmentioning

confidence: 93%

A literature review of bioactive substances for the treatment of periodontitis: In vitro, in vivo and clinical studies

Kim,

Heo,

Chandika

et al. 2024

Heliyon

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Section: Resultsmentioning

confidence: 93%

A literature review of bioactive substances for the treatment of periodontitis: In vitro, in vivo and clinical studies

Kim,

Heo,

Chandika

et al. 2024

Heliyon

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“…7,8,10,16 Some strategies have been proposed to overcome this situation, such as a single dose of broad-spectrum intravenous antibiotics immediately before the biopsy in addition to oral quinolone, which has proven useful in reducing IC; however, the risk of inducing bacterial resistance is further increased. 17,18 Adoption of targeted antibiotic prophylaxis based on a rectal swab is another strategy and a meta-analysis that evaluated 12,320 patients found lower IC rates (0.8% vs 3.4%), 14,19 but there are studies that have not observed this benefit. 18,20 The transperineal biopsy is undoubtedly the best option because it prevents the needle from passing through the rectal wall.…”

Section: Discussionmentioning

confidence: 99%

“…17,18 Adoption of targeted antibiotic prophylaxis based on a rectal swab is another strategy and a meta-analysis that evaluated 12,320 patients found lower IC rates (0.8% vs 3.4%), 14,19 but there are studies that have not observed this benefit. 18,20 The transperineal biopsy is undoubtedly the best option because it prevents the needle from passing through the rectal wall. A metaanalysis of 11 studies, including 1,644 transperineal and 1,634 transrectal biopsies, found a 74% reduction in ICs.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Purpose:Prostate biopsy is mostly performed through the transrectal route worldwide and infectious complications may occur in up to 7% of cases. Therefore, alternative strategies to decrease infectious complications are needed. Our aim was to evaluate the effectiveness of intrarectal povidone-iodine cleansing plus formalin disinfection of the needle tip in decreasing infectious complications after transrectal ultrasound guided prostate biopsy.Materials and Methods:We conducted a prospective, single-center, phase III trial in patients undergoing transrectal ultrasound guided prostate biopsy randomized 1:1 to rectal mucosa cleansing with gauze soaked in 10% povidone-iodine solution wrapped around the gloved index finger and needle tip disinfection by immersion in a 10% formalin solution before each puncture vs control group. The primary end point was the rate of infectious complications defined as 1 or more of the following events: fever, urinary tract infection, or sepsis.Results:Overall, 633 patients were randomized to the intervention group and 623 to the control group. The infectious complication rate was 3.9% in the intervention group and 6.4% in the control group (RR 0.61; 95% CI 0.36-0.99; P = .049). The rates of sepsis, urinary tract infection, and fever were 0.3% vs 0.5% (P = .646), 2.3% vs 4.1% (P = .071), and 1.3% vs 1.9% (P = .443), respectively. The positive urine culture rate was 5.2% in the intervention group and 9% in the control group (RR 0.57; P = .015). There was no statistically significant difference between the groups regarding the occurrence of noninfectious adverse events.Conclusions:Intrarectal povidone-iodine cleansing plus formalin disinfection of the biopsy needle tip was associated with a reduction in infectious complications after transrectal prostate biopsy.

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“…Ongün et al [27] demonstrated a lower incidence of urinary tract infections in patients receiving fosfomycin prophylaxis compared to fluoroquinolones. Seyed [28] and colleagues investigated the combination of aminoglycosides and oral antibiotics for three days along with povidone-iodine rectal cleansing and concluded that this may represent an optimum strategy to minimize the risk after TRUSBx. Derin [29] described important repercussions, such as an increased incidence of infectious complications with limited use of fluoroquinolones as the first-choice antibiotics for prophylaxis in prostate biopsies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Fluoroquinolones and Other Antibiotic Prophylaxis Regimens for Preventing Complications in Patients Undergoing Transrectal Prostate Biopsy

et al. 2022

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Our study aimed to compare the incidence of infective complications after transrectal ultrasound-guided prostate biopsy (TRUSBx) when adopting different antimicrobial prophylaxis regimens. A multi-institutional cohort of 1150 patients who underwent TRUSBx was retrospectively analyzed. Procedures were performed between 2017 and 2019 (before and after the EMA warning about the use of fluoroquinolones for the antibiotic prophylaxis of patient candidates to TRUSBx). The primary endpoint was the occurrence of infective complications, including sepsis and/or fever. The population was stratified according to the antibiotic prophylaxis adopted: fluoroquinolones (levofloxacin, ciprofloxacin, prulifloxacin), cephalosporins (cefixime, ceftriaxone) or trimethoprim/sulfamethoxazole. Univariable and multivariable binomial logistic regression models were used to assess the odds ratio (OR) with 95% confidence interval (CI) testing of the risk of infective complication after adjusting for each prebiopsy covariate. In total, 478 (41.6%) patients received fluoroquinolone-based prophylaxis. Among these, 443 (38.5%), 25 (2.2%) and 10 (0.9%) patients received levofloxacin prophylaxis, ciprofloxacin and prulifloxacin, respectively while 14.6% received cefixime, 20.7% received the comedication of ceftriaxone/fosfomycin and 23.1% received trimethoprim/sulfamethoxazole. The trimethoprim/sulfamethoxazole and fluoroquinolone regimens were significantly associated with a lower risk of infective complications (OR 0.15, 95% CI 0.03–0.48, p = 0.003 and OR 0.17, 95% CI 0.06–0.43, p < 0.001, respectively). The ceftriaxone/fosfomycin (OR 0.21, 95% CI 0.04–0.92, p = 0.04) and fluoroquinolone (OR 0.07, 95% CI 0.00–0.70, p = 0.048) prophylaxis were associated with a lower risk of infective sequelae. Fluoroquinolone-based prophylaxis was associated with a lower risk of infective complications after TRUSBx compared to other prophylaxis regimens although its clinical application was recently forbidden by European Medical Agency restrictions.

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A Systematic Review and Meta-Analysis of Methods Used to Reduce Infectious Complications Following Transrectal Prostate Biopsy

Cited by 4 publications

References 38 publications

A literature review of bioactive substances for the treatment of periodontitis: In vitro, in vivo and clinical studies

A literature review of bioactive substances for the treatment of periodontitis: In vitro, in vivo and clinical studies

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

Comparison of Fluoroquinolones and Other Antibiotic Prophylaxis Regimens for Preventing Complications in Patients Undergoing Transrectal Prostate Biopsy

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