title: Povidone-iodine rectal cleansing and targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound-guided prostate biopsy are associated with reduced incidence of postoperative infectious complications.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of povidone-iodine rectal disinfection and targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound-guided prostate biopsy based on rectal swab culture results.
  
  
  METHODS
  From January 2011 to December 2015, we studied differences in infectious complications in men who received povidone-iodine rectal disinfection with targeted antimicrobial prophylaxis and those who received empirical prophylaxis before transrectal ultrasound-guided prostate biopsy. Clinical variables including demographics, prior antibiotic, rectal swab culture results, povidone-iodine rectal cleansing, antibiotic prophylaxis, and infectious complications were evaluated. Patients were divided into three groups as follows: Group A received no povidone-iodine rectal cleansing but received empirical antimicrobial prophylaxis; group B received povidone-iodine rectal cleansing and empirical antimicrobial prophylaxis; and group C received povidone-iodine rectal cleansing and targeted antimicrobial prophylaxis.
  
  
  RESULTS
  Patients were divided into group A (n = 192; 13.2 %), group B (n = 579; 39.9 %), or group C (n = 679; 46.8 %). In groups A and B, all patients received fluoroquinolone antimicrobial prophylaxis. Group C patients received targeted antimicrobial prophylaxis according to antibiotic resistance of rectal flora, and 71.1 % of these received fluoroquinolone antimicrobial prophylaxis. Infectious complication rates were 3.6, 2.9, and 1.3 % in group A, group B, and group C, respectively. Incidences of acute prostatitis and bacteremia were significantly lower in group C (p = 0.041 and p = 0.049, respectively) than in the other groups.
  
  
  CONCLUSIONS
  In the era of quinolone resistance, the combination of povidone-iodine rectal cleansing and targeted antibiotic prophylaxis may reduce the rate of infectious complications.
authors: Department of Urology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
authors: Ji Won
authors: JW
authors: Ryu
authors: Department of Urology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea. drjsi@yahoo.co.kr.
authors: Seung Il
authors: SI
authors: Jung
authors: Department of Urology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
authors: Ji Hoon
authors: JH
authors: Ahn
authors: Department of Urology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
authors: Eu Chang
authors: EC
authors: Hwang
authors: Department of Urology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
authors: Ho Song
authors: HS
authors: Yu
authors: Department of Urology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
authors: Taek Won
authors: TW
authors: Kang
authors: Department of Urology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
authors: Dong Deuk
authors: DD
authors: Kwon
authors: Department of Urology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
authors: Kwangsung
authors: K
authors: Park
authors: Department of Radiology, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors: Jin Woong
authors: JW
authors: Kim
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects / Q000379:methods; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011467:Prostate / Q000473:pathology; D011472:Prostatitis / Q000209:etiology / Q000517:prevention & control; D012007:Rectum / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D024841:Fluoroquinolones; D011206:Povidone-Iodine
keywords: Biopsy; Fluoroquinolone; Infection; Prostate