title: Peri-procedural povidone-iodine rectal preparation reduces microorganism counts and infectious complications following ultrasound-guided needle biopsy of the prostate.
abstract: OBJECTIVE
  The purpose of the study was to evaluate whether a peri-procedural povidone-iodine rectal preparation (PIRP) prior to transrectal ultrasound-guided prostate needle biopsy (TRUS PNB) can reduce microorganism colony counts and infectious complications.
  
  
  METHODS
  Our institutional TRUS PNB database was reviewed to identify infectious post-biopsy complications (defined as fever >38.5 °C with positive culture). The last 570 biopsy patients were divided into those administered only preoperative oral and/or parenteral antibiotics (n = 456; chronologically cohorts A-D) versus men receiving peri-procedural PIRP in conjunction with standard preoperative antibiotics (n = 114; cohort E). Rectal cultures were obtained in the PIRP cohort to quantify changes in microorganism colony counts.
  
  
  RESULTS
  Mean baseline PSA for patients was 11.6 ng/ml, 63 % were undergoing an initial biopsy, and 17 % had documented use of antibiotic therapy within the previous 6 months. A reduction in infectious complications was observed when comparing the conventional antibiotic (cohorts A-D) versus PIRP (cohort E) group (1.8 vs. 0 %), with the largest magnitude of decline occurring in the concurrent contemporary cohorts (cohort D-5.3 % vs. cohort E-0 %, p = 0.03). Rectal cultures obtained in 92 men before and after PIRP administration noted a 97 % reduction in microorganism colonies (2.1 × 10(5) vs. 6.3 × 10(3) CFU/ml, p < 0.001). No adverse reactions to the PIRP were reported by patients 7 days post-biopsy.
  
  
  CONCLUSIONS
  Peri-procedural PIRP decreased microorganism colony counts and effectively reduced infectious complications following TRUS PNB. This safe, cheap, and simple strategy may be a reasonable alternative to systemic or targeted antibiotic therapy to reduce post-biopsy infections.
authors.affiliation: Division of Urology, Penn State Milton S. Hershey Medical Center, 500 University Drive, H055, Hershey, PA, 17033-0850, USA.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Gyorfi
authors.forename: Christopher
authors.initials: C
authors.lastname: Otteni
authors.forename: Kevin
authors.initials: K
authors.lastname: Brown
authors.forename: Amar
authors.initials: A
authors.lastname: Patel
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lehman
authors.forename: Brett E
authors.initials: BE
authors.lastname: Phillips
authors.forename: Kalyan
authors.initials: K
authors.lastname: Dewan
authors.forename: Girish
authors.initials: G
authors.lastname: Kirimanjeswara
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control*; D001707:Biopsy, Needle / Q000379:methods*; D006801:Humans; D061705:Image-Guided Biopsy; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011467:Prostate / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology*; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine