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

Area of Science:

• Urology
• Infectious Diseases
• Clinical Trials

Background:

• Transrectal prostate biopsy (TRPB) is a common procedure for diagnosing prostate cancer.
• Infectious complications (IC) are a significant concern following TRPB.
• Reducing IC is crucial for patient safety and procedural success.

Purpose of the Study:

• To identify the most effective methods for reducing infectious complications (IC) after transrectal prostate biopsy (TRPB).
• To analyze data from prospective randomized-controlled trials to determine optimal preventative strategies.

Main Methods:

• Systematic review and analysis of prospective randomized-controlled trials (RCTs) focusing on TRPB.
• Comparison of different antibiotic regimens, antibiotic classes, and rectal cleansing methods.
• Statistical analysis to determine the efficacy of various interventions in reducing IC.

Main Results:

• No significant difference in IC rates between fluoroquinolones and other antibiotic classes.
• No superiority of targeted over empiric antibiotic regimens.
• Significantly lower IC rates with longer antibiotic courses (≥3 days), combination therapy (fluoroquinolones + aminoglycosides), and povidone-iodine rectal cleansing.

Conclusions:

• Optimal strategy to minimize IC after TRPB involves a 3-day course of oral antibiotics with aminoglycosides plus povidone-iodine rectal cleansing.
• Empiric antibiotic choice and duration are key factors in preventing TRPB-related infections.
• Povidone-iodine rectal preparation is a valuable adjunct to antibiotic prophylaxis.