Procedural povidone iodine rectal preparation reduces bacteriuria and bacteremia following prostate needle biopsy
Jordan L Allen1, Kathleen Lehman, Kalyan Dewan
1Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Introduction:
To determine if a povidone iodine rectal preparation (PIRP) reduces rates of bacteriuria and bacteremia following transrectal ultrasound guided prostate needle biopsy (TRUS PNB).
Materials And Methods:
Men undergoing TRUS PNB were prospectively enrolled in a study comparing the impact of PIRP versus standard of care (two pills of ciprofloxacin 500 mg). Urine, blood, and rectal cultures were obtained 30 minutes post-procedure with colony forming units (CFUs) determined after 48 hours. Patients were called 7 and 30 days post-procedure to evaluate for infections.
Results:
A total of 150 men were accrued into this study including 95 receiving PIRP and 55 the standard of care. Two-thirds of patients were undergoing an initial biopsy, 19% used antibiotics within the previous 6 months, and median number of biopsy cores was 14. There were no differences between the two cohorts with respect to baseline or biopsy characteristics. In the PIRP cohort, rectal cultures before and after PIRP administration noted a 97.2% reduction in microorganism colonies (2.4 x 10 5 CFU/mL versus 6.7 x 10³CFU/mL, p < 0.001). Mean urine bacterial counts following TRUS PNB were 1 CFU/mL for PIRP versus 7 CFU/mL for standard cohort (p < 0.001). Mean serum bacterial counts following TRUS PNB were 0 CFU/mL for PIRP versus 3 CFU/mL for standard of care (p = 0.01). One patient in the PIRP cohort (1.1%) developed post-biopsy sepsis while 3 (5.5%) in the standard cohort had an infectious complication (1 UTI, 2 sepsis).
Conclusion:
A PIRP regimen reduced bacteruria and bacteremia following TRUS PNB.
Insights
Povidone iodine rectal preparation (PIRP) significantly reduced bacteriuria and bacteremia following prostate biopsies. This infection prevention method is more effective than standard antibiotic prophylaxis for transrectal ultrasound guided prostate needle biopsy (TRUS PNB).
Area of Science:
- Urology
- Infectious Disease Prevention
- Medical Microbiology
Background:
- Transrectal ultrasound guided prostate needle biopsy (TRUS PNB) carries a risk of infectious complications.
- Current prophylactic strategies, including antibiotics, have limitations in preventing bacteriuria and bacteremia.
Purpose of the Study:
- To evaluate the efficacy of povidone iodine rectal preparation (PIRP) in reducing infectious complications after TRUS PNB.
- To compare PIRP with standard antibiotic prophylaxis (ciprofloxacin).
Main Methods:
- A prospective study involving 150 men undergoing TRUS PNB.
- Comparison between PIRP and standard care (ciprofloxacin).
- Collection of urine, blood, and rectal cultures post-procedure; patient follow-up for infections at 7 and 30 days.
Main Results:
- PIRP demonstrated a 97.2% reduction in rectal microorganism colonies.
- Significantly lower mean urine bacterial counts (1 CFU/mL vs. 7 CFU/mL) and serum bacterial counts (0 CFU/mL vs. 3 CFU/mL) in the PIRP group.
- Lower incidence of infectious complications in the PIRP cohort (1.1% vs. 5.5%).
Conclusions:
- Povidone iodine rectal preparation is an effective strategy for reducing bacteriuria and bacteremia post-TRUS PNB.
- PIRP offers a promising alternative or adjunct to antibiotic prophylaxis for preventing infections associated with prostate biopsies.
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