Minimizing transrectal prostate biopsy-related infections; A prospective randomized trial of povidone-iodine intrarectal cleaning versus formalin needle disinfection

Abstract

Introduction: Transrectal prostate biopsies are associated with post biopsy infection and sepsis. We compared the efficacy of povidone-iodine rectal disinfection versus formalin needle disinfection in preventing post biopsy infection among patients undergoing transrectal ultrasound-guided prostate biopsy. Methods: Patients scheduled to undergo ultrasound-guided transrectal prostate biopsy ( n = 621) over 20 months were randomized into 2 groups to receive either povidone-iodine intrarectal disinfection or formalin disinfection of needle after each core. These were compared to assess which methodology better prevented postprocedure infection. Statistical analysis were used to identify independent factors promoting infections. Results: Two hundred and ninety-eight patients from povidone-iodine intrarectal disinfection were compared with 300 from formalin needle disinfection group. Formalin needle disinfection was associated with significantly more infections ( P = 0.02). Escherichia coli was the dominant pathogen, with >50% of cases being quinolone resistant. Type of disinfection ( P = 0.002), BMI ( P = 0.001), chronic prostatitis ( P = 0.002), and diabetes mellitus ( P = 0.01) were independent predictors of infections. BMI at 28.95 kg/m 2 provided the best predictive cut-off point for infections, irrespective of method of disinfection. Area under the curve for all these parameters together was 0.91. Conclusions: We conclude that along with oral cephalosporin prophylaxis, povidone-iodine intrarectal disinfection is a superior to formalin needle disinfection alone in preventing post biopsy infection. Patients with BMI >28.95 kg/m 2 should be considered at a higher risk for infections.

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

“…However, in the literature, there are a minimal number of studies containing biopsy ND methods by formalin, alcohol, or PI. These studies are summarized in Table 2 4–7,14–17 . Except for one study which compares ND versus PI rectal cleaning, 16 the other studies demonstrated lower PBIC rates compared to non‐ND‐applied patients.…”

“…These studies are summarized in Table 2 4–7,14–17 . Except for one study which compares ND versus PI rectal cleaning, 16 the other studies demonstrated lower PBIC rates compared to non‐ND‐applied patients.…”

Povidone Iodine Intrarectal Cleaning versus Formalin Needle Disinfection for Minimizing Transrectal Prostate Biopsy-related Infections

“…Patients underwent a 12-core biopsy protocol, including six parasagittal and six laterally targeted cores covering the base, mid-zone, and apex in the daycare setting using spring-loaded 18G core biopsy needle. Post-biopsy infection definitions are: a) UTI: Bacteriuria with pyuria by microscopy within a week of biopsy with signs of chills, dysuria, frequency, urgency & temperature <100.4 °F b) Bacteremia: Bacterial growth in blood culture c) Sepsis: Systemic inflammatory response syndrome (presence of t2 of the following: Temperature t100.4°F or <96.8°F; tachycardia >90 beats/min; tachypnea >20 breaths/ min or respiratory alkalosis paCO2 d32 mmHg; leukocytosis t12000 or leukopenia d4000 due to infection) 2 . The Endpoint of the study was the development of signs and symptoms of infection within 7 days of prostate biopsy.…”

“…Therefore, a small percentage of post-biopsy complications significantly affect a large portion of the population's health. The most feared complication of transrectal prostate biopsy is post-biopsy infection and sepsis 2 . During a transrectal prostate biopsy, fecal matter may be introduced into the prostate causing infection.…”

“…Both are effective measures to prevent post-biopsy infection than performing prostate biopsy with antibiotic prophylaxis alone. Literature proving enhanced efficacy of povidone-iodine instillation than formalin needle disinfection after every core of the biopsy is lacking 2 . So, this study has been designed to assess the effectiveness of these two methods for preventing infection during prostate biopsy.…”