Rectal Disinfection with Povidone-Iodine Reduces Infection Rates in Prostate Biopsy Procedures, reveals study

A recent meta-analysis published in the World Journal of Urology found that using povidone-iodine (PI) for rectal disinfection before transrectal ultrasound-guided prostate biopsies (TRUS-PB) can significantly reduce the infectious complications. The study compiled data from 10 randomized controlled trials that involved several thousand patients and highlighted that combining antibiotic prophylaxis (AP) with PI is more effective than using antibiotics alone.

Transrectal ultrasound-guided prostate biopsy is a common procedure used to diagnose prostate cancer. However, this method carries a risk of infection since the biopsy needle passes through the rectal wall by exposing the puncture site to potential bacterial contamination. Traditionally, this risk has been managed with antibiotics, but rising rates of antibiotic resistance have made this strategy less effective.

This meta-analysis reviewed studies until November 2023 and found that the rates of overall infectious complications were 44% lower in groups where PI was used for rectal disinfection when compared to groups where PI was not used. This finding was significant where the relative risk (RR) was 0.56 and a 95% of confidence interval (CI) from 0.42 to 0.74.

The combination of PI with antibiotic prophylaxis found that this protocol further reduced the risk of infectious complications (RR 0.54, CI 0.40-0.73) and significantly reduced the occurrence of fever post-procedure (RR 0.47, CI 0.30-0.75). However, the analysis did not find a significant reduction in the rates of sepsis although there was a trend towards benefit (RR 0.49, CI 0.23-1.04).

Also, this study examined the impact of different antibiotics used in conjunction with PI. The results indicated that fluoroquinolone antibiotics were more effective in reducing infectious complications and fever when compared to other types of antibiotics by suggesting that the choice of antibiotic also plays a pivotal role in the outcome of TRUS-PB.

These findings are crucial, as concerns about antibiotic resistance grow and the medical community seeks more effective methods to prevent procedure-related infections. The use of povidone-iodine offers a simple and cost-effective strategy to improve patient safety during one of the most common diagnostic procedures for prostate cancer. Overall, these findings may prompt a shift in clinical practices regarding pre-procedural preparation for prostate biopsies.

Source:

Tsuboi, I., Matsukawa, A., Parizi, M. K., Klemm, J., Mancon, S., Chiujdea, S., Fazekas, T., Laukhtina, E., Kawada, T., Katayama, S., Iwata, T., Bekku, K., Wada, K., Araki, M., & Shariat, S. F. (2024). Infection risk reduction with povidone-iodine rectal disinfection prior to transrectal prostate biopsy: an updated systematic review and meta-analysis. In World Journal of Urology (Vol. 42, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1007/s00345-024-04941-2