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Infection Risk Reduction With Povidone-Iodine Rectal Disinfection Prior to Transrectal Prostate Biopsy: An Updated Systematic Review and Meta-Analysis Publisher Pubmed



Tsuboi I1, 2, 3 ; Matsukawa A1, 4 ; Parizi MK1, 5 ; Klemm J1, 6 ; Mancon S1, 7 ; Chiujdea S1, 8 ; Fazekas T1, 9 ; Laukhtina E1, 10 ; Kawada T1, 3 ; Katayama S1, 3 ; Iwata T1, 3 ; Bekku K1, 3 ; Wada K1, 2 ; Araki M3 Show All Authors
Authors
  1. Tsuboi I1, 2, 3
  2. Matsukawa A1, 4
  3. Parizi MK1, 5
  4. Klemm J1, 6
  5. Mancon S1, 7
  6. Chiujdea S1, 8
  7. Fazekas T1, 9
  8. Laukhtina E1, 10
  9. Kawada T1, 3
  10. Katayama S1, 3
  11. Iwata T1, 3
  12. Bekku K1, 3
  13. Wada K1, 2
  14. Araki M3
  15. Shariat SF1, 9, 11, 12, 13, 14, 15, 16
Show Affiliations
Authors Affiliations
  1. 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Wahringer Gurtel 18-20, Vienna, 1090, Austria
  2. 2. Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
  3. 3. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  4. 4. Department of Urology, Jikei University School of Medicine, Tokyo, Japan
  5. 5. Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  7. 7. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
  8. 8. Department of Urology, Spitalul Clinic Judetean Murures, University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Mures, Romania
  9. 9. Department of Urology, Semmelweis University, Budapest, Hungary
  10. 10. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
  11. 11. Department of Urology, University of Texas Southwestern, Dallas, TX, United States
  12. 12. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
  13. 13. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
  14. 14. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
  15. 15. Research Center of Evidence Medicine, Urology Department Tabriz University of Medical Sciences, Tabriz, Iran
  16. 16. Department of Urology, Weill Cornell Medical College, New York, NY, United States

Source: World Journal of Urology Published:2024


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. © The Author(s) 2024.