Infection risk reduction with povidone-iodine rectal disinfection prior to transrectal prostate biopsy: an updated systematic review and meta-analysis.

Kensuke Bekku, Mehdi Kardoust Parizi, Jakob Klemm, Sever Chiujdea, Takehiro Iwata, Ekaterina Laukhtina, Koichiro Wada, Motoo Araki, Shahrokh F Shariat, Akihiro Matsukawa, Ichiro Tsuboi, Stefano Mancon, Tamás Fazekas, Tatsushi Kawada, Satoshi Katayama

Journal: World journal of urology 2024;42(1):252

PMID: 38652324

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Abstract

BACKGROUND

To prevent infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB), some studies have investigated the efficacy of rectal disinfection using povidone-iodine (PI) and antibiotic prophylaxis (AP).

OBJECTIVE

To summarize available data and compare the efficacy of rectal disinfection using PI with non-PI methods prior to TRUS-PB.

EVIDENCE ACQUISITION

Three databases were queried through November 2023 for randomized controlled trials (RCTs) analyzing patients who underwent TRUS-PB. We compared the effectiveness of rectal disinfection between PI groups and non-PI groups with or without AP. The primary outcomes of interest were the rates of overall infectious complications, fever, and sepsis. Subgroups analyses were conducted to assess the differential outcomes in patients using fluoroquinolone groups compared to those using other antibiotics groups.

EVIDENCE SYNTHESIS

We included ten RCTs in the meta-analyses. The overall rates of infectious complications were significantly lower when rectal disinfection with PI was performed (RR 0.56, 95% CI 0.42-0.74, p < 0.001). Compared to AP monotherapy, the combination of AP and PI was associated with significantly lower risk of infectious complications (RR 0.54, 95% CI 0.40-0.73, p < 0.001) and fever (RR 0.47, 95% CI 0.30-0.75, p = 0.001), but not with sepsis (RR 0.49, 95% CI 0.23-1.04, p = 0.06). The use of fluoroquinolone antibiotics was associated with a lower risk of infectious complications and fever compared to non-FQ antibiotics.

CONCLUSION

Rectal disinfection with PI significantly reduces the rates of infectious complications and fever in patients undergoing TRUS-PB. However, this approach does not show a significant impact on reducing the rate of sepsis following the procedure.

Address: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan.; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Department of Urology, Jikei University School of Medicine, Tokyo, Japan.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Department of Urology, Spitalul Clinic Judetean Murures, University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Mures, Romania.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Department of Urology, Semmelweis University, Budapest, Hungary.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.; Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan.; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria. [email protected].; Department of Urology, Semmelweis University, Budapest, Hungary. [email protected].; Department of Urology, University of Texas Southwestern, Dallas, TX, USA. [email protected].; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. [email protected].; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan. [email protected].; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. [email protected].; Research Center of Evidence Medicine, Urology Department Tabriz University of Medical Sciences, Tabriz, Iran. [email protected].; Department of Urology, Weill Cornell Medical College, New York, NY, USA. [email protected].

DOI: 10.1007/s00345-024-04941-2

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MeSH Terms: Humans, Male, Anti-Infective Agents, Local, Antibiotic Prophylaxis, Disinfection, Image-Guided Biopsy, Povidone-Iodine, Prostate, Prostatic Neoplasms, Rectum