Correction To: Infection Risk Reduction With Povidone-Iodine Rectal Disinfection Prior to Transrectal Prostate Biopsy: An Updated Systematic Review and Meta-Analysis (World Journal of Urology, (2024), 42, 1, (252), 10.1007/S00345-024-04941-2) Publisher Pubmed



Tsuboi I^{1, 2, 3} ; Matsukawa A^{1, 4} ; Parizi MK^{1, 5} ; Klemm J^{1, 6} ; Mancon S^{1, 7} ; Chiujdea S^{1, 8} ; Fazekas T^{1, 9} ; Laukhtina E^{1, 10} ; Kawada T^{1, 3} ; Katayama S^{1, 3} ; Iwata T^{1, 3} ; Bekku K^{1, 3} ; Wada K^{1, 2} ; Araki M³ Show All Authors Show Affiliations
Source: World Journal of Urology Published:2024

Abstract

Unfortunately, the published article contains some errors, the corrected article can be found below. 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 nine RCTs in the meta-analyses. The overall rates of infectious complications were significantly lower when rectal disinfection with PI was performed (RR 0.58, 95% CI 0.43–0.76, p < 0.001). Compared to AP monotherapy, the combination of AP and PI was associated with significantly lower risk of infectious complications (RR 0.47, 95% CI 0.30–0.73, 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. Antibiotic prophylaxis Povidone-iodine Transrectal ultrasound-guided prostate biopsy Transrectal ultrasound-guided prostate biopsy (TRUS-PB) and transperineal ultrasound-guided prostate biopsy (TPUS-PB) have been the main procedures to diagnose prostate cancer [1]. Despite the recommendations of the European Association of Urology (EAU) guidelines favoring TPUS-PB over TRUS-Bx, the transrectal approach is still widely utilized worldwide, mainly due to the elaborate technical requirements of TPUS-Bx. However, TRUS-Bx leads to higher incidence of infectious complications based on the translocation of rectal bacteria during the procedure. The estimated incidence rate of infectious complications by TRUS-PB, such as acute bacterial prostatitis, fever, and sepsis, is reported to be as high as 6.3% [2, 3]. Several studies, including randomized controlled trials (RCT), have been conducted to assess the efficacy of PI disinfection of the rectum in reducing infectious complications after TRUS-PB [2, 4–9]. These studies have indicated that PI disinfection can reduce infectious complications, leading to the EAU guidelines to recommend rectal disinfection with PI prior to TRUS-PB [10]. Although previous systematic reviews and meta-analyses compared the efficacy of PI to reduce infection between the PI group and non-PI group and between the PI plus AP group and AP monotherapy group, the efficacy of using PI in reducing sepsis remains uncertain when comparing PI plus AP and AP monotherapy [4, 9]. Therefore, the aim of this systematic review and meta-analysis was to evaluate the efficacy of pre-TRUS-PB disinfection with PI plus AP compared to AP monotherapy. We aimed to reassess the role of PI in mitigating infectious complications. Furthermore, we make efforts to clarify and verify the effectiveness of PI in reducing the incidence of sepsis. We registered the study with the International Prospective Register of Systematic Reviews (PROSPERO: registration number: CRD42023476473). This systematic review and meta-analysis was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (PRISMA 2020 checklist, Supplementary Table 1). On November 1st, 2023, the PubMed, Scopus, and Web of Science databases were searched to identify studies investigating the effectiveness of disinfection with PI before TRUS-PB. The search terms included: “prostate biopsy”, “povidone iodine”. The detailed search strategy is shown in Supplementary Appendix 1. Two investigators independently performed an initial screening based on the titles and abstracts and noted the cause of exclusion of ineligible reports. Full texts were retrieved and evaluated for eligibility. In addition, hand searches of reference lists were performed to identify additional studies of interest. © The Author(s) 2024.