title: A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy.
abstract: OBJECTIVE
  Transrectal ultrasound guided prostate biopsy can lead to urinary tract infections in 3% to 11% and sepsis in 0.1% to 5% of patients. We investigated the efficacy of rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy to reduce infectious complications.
  
  
  METHODS
  Between 2009 and 2011, 865 men were prospectively randomized to rectal cleansing (421) or no cleansing (444) before transrectal ultrasound guided prostate biopsy. Patients received ciprofloxacin prophylaxis and rectal swab cultures were obtained before transrectal ultrasound guided prostate biopsy. Patients completed a telephone interview 7 days after undergoing the biopsy. The primary end point was the rate of infectious complications, a composite end point of 1 or more of 1) fever greater than 38.0C, 2) urinary tract infection or 3) sepsis (standardized definition). Chi-square significance testing was performed for differences between groups and a multivariate analysis was performed to assess risk factors for infectious complications.
  
  
  RESULTS
  Infectious complications were observed in 31 (3.5%) patients, including 11 (2.6%) treated and 20 (4.5%) control patients (p = 0.15). Sepsis was observed in 4 (1.0%) treated and 7 (1.6%) control patients (p = 0.55). On multivariate analysis resistance to ciprofloxacin in the rectal swab culture (p = 0.002) and a history of taking ciprofloxacin in the 3 months preceding transrectal ultrasound guided prostate biopsy (p = 0.009) predicted infectious complications.
  
  
  CONCLUSIONS
  Rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy was safe, but the 42% relative risk reduction of infectious complications was not statistically significant. Patients who have received ciprofloxacin within 3 months of transrectal ultrasound guided prostate biopsy should be considered for alternate prophylaxis or possibly a delay of biopsy beyond 3 months.
authors.affiliation: Department of Urologic Sciences, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Zeid
authors.initials: Z
authors.lastname: Abughosh
authors.forename: Joseph
authors.initials: J
authors.lastname: Margolick
authors.forename: S Larry
authors.initials: SL
authors.lastname: Goldenberg
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Taylor
authors.forename: Kourosh
authors.initials: K
authors.lastname: Afshar
authors.forename: Robert
authors.initials: R
authors.lastname: Bell
authors.forename: Dirk
authors.initials: D
authors.lastname: Lange
authors.forename: William R
authors.initials: WR
authors.lastname: Bowie
authors.forename: Diane
authors.initials: D
authors.lastname: Roscoe
authors.forename: Lindsay
authors.initials: L
authors.lastname: Machan
authors.forename: Peter C
authors.initials: PC
authors.lastname: Black
mesh_terms: D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000517:prevention & control*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D012007:Rectum; D018084:Ultrasonography, Interventional
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine