1080 A PROSPECTIVE RANDOMIZED TRIAL OF POVIDONE-IODINE PROPHYLACTIC CLEANSING OF THE RECTUM PRIOR TO TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY (2012)

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20121080 A PROSPECTIVE RANDOMIZED TRIAL OF POVIDONE-IODINE PROPHYLACTIC CLEANSING OF THE RECTUM PRIOR TO TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY Zeid Abughosh, Joseph Margolick, S. Larry Goldenberg, Kourosh Afshar, Stephen Taylor, Dirk Lange, Ben Chew, Martin Gleave, Alan So, Martin McLoughlin, William Bowie, Diane Roscoe, Lindsay Machan, and Peter Black Zeid AbughoshZeid Abughosh Zarqa, Jordan More articles by this author , Joseph MargolickJoseph Margolick Vancouver, Canada More articles by this author , S. Larry GoldenbergS. Larry Goldenberg Vancouver, Canada More articles by this author , Kourosh AfsharKourosh Afshar Vancouver, Canada More articles by this author , Stephen TaylorStephen Taylor Vancouver, Canada More articles by this author , Dirk LangeDirk Lange Vancouver, Canada More articles by this author , Ben ChewBen Chew Vancouver, Canada More articles by this author , Martin GleaveMartin Gleave Vancouver, Canada More articles by this author , Alan SoAlan So Vancouver, Canada More articles by this author , Martin McLoughlinMartin McLoughlin Vancouver, Canada More articles by this author , William BowieWilliam Bowie Vancouver, Canada More articles by this author , Diane RoscoeDiane Roscoe Vancouver, Canada More articles by this author , Lindsay MachanLindsay Machan Vancouver, Canada More articles by this author , and Peter BlackPeter Black Vancouver, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1187AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Infectious complications (IC) after transrectal ultrasound-guided prostate biopsy (TRUSBx) include bladder and prostate infections in 3-11% and sepsis in 0.1-5% of patients, even after antibiotic prophylaxis. This ethics-board approved clinical trial investigated the safety and efficacy of Povidone-iodine prophylactic cleansing of the rectum prior to TRUSBx on the rate of IC. METHODS 1069 men were invited to participate in this trial, of whom 865 met criteria and were randomized prospectively to undergo TRUSBx with (n=421, “treatment”) or without (n=444; “control”) rectal cleansing. All patients delivered urine and rectal swab cultures prior to TRUSBx and received a 3 day course of ciprofloxacin prophylaxis. Patients measured their temperature for 48 hours after TRUSBx, delivered a urine culture after 48 hours, and completed a telephone interview after 7 days. The primary endpoint was the rate of IC, a composite endpoint consisting of: 1. fever >38.0°C, 2. urinary tract infection (UTI), or, 3. sepsis (standardized definition). Chi- square (X2) significance testing was performed for differences between groups, and a multivariate analysis was performed to assess risk factors for IC. RESULTS IC was observed in 31 patients (3.5%), including 11 (2.6%) treated and 20 (4.5%) control patients (p=0.15). Sepsis was observed in 1.0% of treated and 1.6% of control patients (p= 0.55). Rectal swab cultures revealed ciprofloxacin resistance in 20% of patients, of whom 3.5% developed IC. Imipenem and piperacillin/tazobactam had the most favorable resistance patterns in the ciprofloxacin resistant organisms (0.1% and 0.7% resistance, respectively). On multivariate analysis, resistance to ciprofloxacin in the rectal swab culture (p<0.001) and a history of taking ciprofloxacin in the three months preceding TRUSBx (p=0.009) predicted IC. No significant adverse effects to rectal cleansing were observed. CONCLUSIONS Rectal cleansing with Povidone- iodine prior to TRUSBx was safe but the 42% relative risk reduction of infections was not statistically significant. Ciprofloxacin-resistant flora were found frequently, but only a small fraction of these patients developed an IC. Patients who have received ciprofloxacin within 3 months of TRUSBx should be considered for alternate prophylaxis or possibly a delay of biopsy beyond 3 months. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e438-e439 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Zeid Abughosh Zarqa, Jordan More articles by this author Joseph Margolick Vancouver, Canada More articles by this author S. Larry Goldenberg Vancouver, Canada More articles by this author Kourosh Afshar Vancouver, Canada More articles by this author Stephen Taylor Vancouver, Canada More articles by this author Dirk Lange Vancouver, Canada More articles by this author Ben Chew Vancouver, Canada More articles by this author Martin Gleave Vancouver, Canada More articles by this author Alan So Vancouver, Canada More articles by this author Martin McLoughlin Vancouver, Canada More articles by this author William Bowie Vancouver, Canada More articles by this author Diane Roscoe Vancouver, Canada More articles by this author Lindsay Machan Vancouver, Canada More articles by this author Peter Black Vancouver, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...