Correction: Infection risk reduction with povidone-iodine rectal disinfection prior to transrectal prostate biopsy: an updated systematic review and meta-analysis - Report - MDSpire
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Correction: Infection risk reduction with povidone-iodine rectal disinfection prior to transrectal prostate biopsy: an updated systematic review and meta-analysis
Efficacy of Povidone-Iodine Rectal Disinfection Before Transrectal Prostate Biopsy
Overview
This updated systematic review and meta-analysis of nine randomized controlled trials demonstrates that rectal disinfection with povidone-iodine (PI) significantly reduces infectious complications and fever rates in patients undergoing transrectal ultrasound-guided prostate biopsy (TRUS-PB). However, PI use does not significantly reduce the incidence of sepsis following the procedure.
Background
Transrectal ultrasound-guided prostate biopsy (TRUS-PB) is a common diagnostic procedure for prostate cancer but carries a risk of infectious complications due to bacterial translocation from the rectum. Infectious complications, including fever and sepsis, occur in up to 6.3% of cases. While the European Association of Urology recommends transperineal biopsy to reduce infection risk, TRUS-PB remains widely used. Rectal disinfection with povidone-iodine (PI) combined with antibiotic prophylaxis (AP) has been investigated to mitigate these risks, but the impact on sepsis rates remains unclear.
Data Highlights
Outcome
Risk Ratio (RR)
95% Confidence Interval (CI)
p-value
Overall Infectious Complications (PI vs Non-PI)
0.58
0.43–0.76
<0.001
Infectious Complications (PI + AP vs AP alone)
0.47
0.30–0.73
0.001
Fever (PI + AP vs AP alone)
0.47
0.30–0.75
0.001
Sepsis (PI + AP vs AP alone)
0.49
0.23–1.04
0.06
Key Findings
Rectal disinfection with povidone-iodine significantly lowers overall infectious complications after TRUS-PB (RR 0.58, p < 0.001).
The combination of PI and antibiotic prophylaxis reduces infectious complications and fever more effectively than antibiotic prophylaxis alone.
PI use does not significantly reduce sepsis rates compared to antibiotic prophylaxis alone (p = 0.06).
Fluoroquinolone antibiotics are associated with lower risks of infectious complications and fever compared to non-fluoroquinolone antibiotics.
The meta-analysis included nine randomized controlled trials with rigorous quality assessment and risk of bias evaluation.
Clinical Implications
Incorporating povidone-iodine rectal disinfection alongside antibiotic prophylaxis can effectively reduce infectious complications and fever in patients undergoing TRUS-PB. However, clinicians should be aware that this strategy does not significantly decrease sepsis risk, and continued vigilance and appropriate antibiotic selection remain essential. Fluoroquinolone antibiotics may offer additional protective benefits against infection in this setting.
Conclusion
Povidone-iodine rectal disinfection is a valuable adjunct to antibiotic prophylaxis in reducing infectious complications and fever following transrectal prostate biopsy, though its impact on sepsis prevention is not statistically significant. These findings support current guideline recommendations for PI use prior to TRUS-PB.
