title: Reducing the risk of infection for transrectal prostate biopsy with povidone-iodine: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the efficacy of povidone-iodine (PI) in reducing the risk of infectious complications following transrectal prostate biopsy (TRPB).
  
  
  METHODS
  Eligible randomized controlled trials (RCTs) were identified from electronic databases (Cochrane CENTRAL, MEDLINE, and EMBASE). The database search, quality assessment, and data extraction were performed independently by two reviewers. The main outcome for the efficacy of PI was the incidence of infectious complications after TRPB.
  
  
  RESULTS
  Seven trials, including 2,049 patients, met the inclusion criteria. Data from the seven included RCTs favored the use of PI before TRPB to prevent infectious complications. PI for "PI versus blank control" significantly reduced fever, bacteriuria, and bacteremia compared with that for control [relative risk (RR) 0.31; 95 % confidence interval (CI) 0.21-0.45, P < 0.00001]. With PI versus antibiotics (ATB), patients treated with ATB alone had a significantly greater risk of bacteremia (RR 0.38; 95 % CI 0.16-0.90, P = 0.03). In "PI plus ATB versus ATB" trials, the risk of fever (RR 0.11; 95 % CI 0.02-0.85, P = 0.03) and bacteremia (RR 0.25; 95 % CI 0.08-0.75, P = 0.01) was diminished in the "PI plus ATB" group.
  
  
  CONCLUSIONS
  Rectal disinfection with PI provides a safe and effective method to reduce the risk of infectious complications following TRPB, regardless of mono-prophylaxis and combined prophylaxis with PI and ATB. Large, multicenter, and prospective RCTs of good quality trials are needed to confirm the efficacy of PI.
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
authors.forename: Chunxiao
authors.initials: C
authors.lastname: Pu
authors.forename: Yunjin
authors.initials: Y
authors.lastname: Bai
authors.forename: Haichao
authors.initials: H
authors.lastname: Yuan
authors.forename: Jinhong
authors.initials: J
authors.lastname: Li
authors.forename: Yin
authors.initials: Y
authors.lastname: Tang
authors.forename: Jia
authors.initials: J
authors.lastname: Wang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wei
authors.forename: Ping
authors.initials: P
authors.lastname: Han
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000517:prevention & control*; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011467:Prostate / Q000473:pathology*; D012007:Rectum; D012306:Risk
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine
references.citation: J Urol. 2013 Jan;189(1 Suppl):S12-7; discussion S17-8
references.pmid: 23234616
references.citation: Iran J Radiol. 2012 Jun;9(2):67-70
references.pmid: 23329966
references.citation: Eur Urol. 2012 Jun;61(6):1110-4
references.pmid: 22244150
references.citation: BJU Int. 2013 May;111(6):946-53
references.pmid: 23464844
references.citation: J Drugs Dermatol. 2011 Apr;10(4):414-7
references.pmid: 21455553
references.citation: Urol Int. 2006;76(4):321-6
references.pmid: 16679833
references.citation: Adv Urol. 2009;:750598
references.pmid: 19404480
references.citation: J Med Assoc Thai. 2009 Dec;92(12):1621-6
references.pmid: 20043564
references.citation: Eur J Cancer. 2013 Apr;49(6):1374-403
references.pmid: 23485231
references.citation: Dis Colon Rectum. 2008 Jun;51(6):966-71
references.pmid: 18311505
references.citation: CA Cancer J Clin. 2013 Jan;63(1):11-30
references.pmid: 23335087
references.citation: J Urol. 2002 Aug;168(2):558-61
references.pmid: 12131309
references.citation: Cochrane Database Syst Rev. 2011 May 11;(5):CD006576
references.pmid: 21563156
references.citation: Masui. 2011 Apr;60(4):499-501
references.pmid: 21520607
references.citation: Urology. 1981 Aug;18(2):145-8
references.pmid: 7269016
references.citation: Clin Microbiol Infect. 2012 Jun;18(6):575-81
references.pmid: 21958149
references.citation: Int Urol Nephrol. 1990;22(3):257-62
references.pmid: 2210982
references.citation: Int Urol Nephrol. 2006;38(1):45-8
references.pmid: 16502051
references.citation: J Urol. 2013 Apr;189(4):1326-31
references.pmid: 23041343
references.citation: Eur Urol. 2013 Mar;63(3):521-7
references.pmid: 22704727
references.citation: Eur Urol. 2011 Jan;59(1):61-71
references.pmid: 21056534
references.citation: Chang Gung Med J. 2006 Jul-Aug;29(4):395-400
references.pmid: 17051837