Presentation Authors: Felipe Costa*, Jose Pontes Jr, Aline Albertini, Tiago M Freire, Eugenio R C Borges, Felipe Pugliesi, Renato Vasconcelos, Bruno Reciputti, Giuliano G Guglielmetti, Vinicius M G Souza, Davi C Constantin, Adalberto Andriolo Jr, Claudio B Murta, Joaquim A Claro, SAO PAULO, Brazil
Introduction: The ultrasound or MRI-guided prostate biopsy is mostly performed through the transrectal route worldwide; and infectious complications are a growing concern, once the rate of resistance to commonly used antibiotics is increasing. Therefore, alternative strategies to decrease infections rates following biopsies are welcome. Our aim was to compare the infectious complications of intrarectal povidone-iodine cleansing associated to formalin disinfection of biopsy needle tip at prostate biopsy.
Methods: A prospective controlled study was conducted enrolling 802 consecutive prostate biopsies with a 1: 1 randomization ratio for two different groups: group A rectal cleansing and disinfection of the needle tip vs. Group B controls at transrectal ultrasound guided prostate biopsy. Patients obtained a urine culture 48 hours after biopsy and completed a telephone interview 7 days after undergoing the procedure. The primary endpoint was the rate of infectious complications, defined as 1 or more of the following events: fever; urinary tract infection (UTI) or sepsis (standardized definition). We also evaluated the predictive factors of infectious complications. This trial is registered in ClinicalTrials.gov
Results: Infectious complications were observed in 33 (4%) patients, of whom, 8 (1%) cases of fever, 14 (1.7%) UTI and 11 (1.4%) sepsis. The rate of infectious complications was lower in group A 2.8% versus 5.3% (OR=0.52 [CI 0.25 1.08], p= 0.07). The overall rate of positive urine culture was also lower in group A 17 (4.9%) when compared to control group B 28 (9.4%) (p=0.026). On multivariate analysis, prior use of urinary indwelling catheters was associated with asymptomatic bacteriuria (p=0.026). Additionally, previous use of antibiotics in the last three months before the biopsy was marginally correlated to higher chance of infectious complications ( 7.2% x 3.5% - p=0.06).
Conclusions: Rectal cleansing with povidone-iodine plus disinfection of biopsy needle tip at transrectal ultrasound guided prostate biopsy was marginally associated with reduction of infectious complications. The previous use of urinary catheters was associated with a greater chance of asymptomatic bacteriuria.