Control of infective complications of transrectal prostate biopsy

To describe a preparatory protocol for prostate biopsy consisting of prophylaxis based on a third-generation cephalosporin and suppository-type povidone-iodine.

From January 2004 to May 2012 we reviewed infective complications in 1,684 patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy. All of the patients received prophylactic antibiotics through a single intravenous injection of a third-generation cephalosporin and cefixime at 100 mg PO for 5 d, with this regimen begun before biopsy, and were also given gynobetadine in a dose of 200 mg just before biopsy. Infectious complications were classified as sepsis, fever (>38°C) without sepsis, and other clinical manifestations of infection. To evaluate the bactericidal effects of gynobetadine, we counted bacterial colonies prospectively in cultures of rectal swab specimens from 150 patients who underwent TRUS-guided prostate biopsy.

Complications occurred in 46 of the patients (2.73%), including infective complications in 11 (0.65%) patients and non-infective complications in 35 (2.08%) patients. Of the patients with infective complications, two had fever without sepsis, none had clinical urinary tract infections without fever, and none had sepsis. In prospective in vitro investigations, the mean bacterial colony count before rectal preparation with an enema or rectal insertion of povidone-iodine suppository was 2.38×10(6), whereas the colony count after a povidone-iodine rectal enema and subsequent biopsy was 1.81×10(3) and the colony count after rectal preparation with povidone-iodine suppository and subsequent biopsy was 8.1×10(2) (all p<0.001).

The administration of cephalosporin-based prophylactic antibiotics and the simple use of suppository-type povidone-iodine provided an excellent protocol for reducing infective complications of TRUS-guided prostate biopsy. The simplicity of use and cost effectiveness of gynobetadine were noteworthy.