Does The Use Of Povidone Iodine Suppository Decrease The Infective Complications Of TRUS Guided Prostate Biopsies? A Randomized Prospective Study

Abstract

Abstract Purpose Trans rectal ultrasound guided prostate biopsy can lead to urinary tract infections in 3% to 11% and sepsis in 0.1% to 5% of patients. We investigated the prevalence of different organisms among rectal flora in our community, the virulence of the most prevalent one and the effect of combined standard antibiotic prophylaxis with the use of povidone iodine suppository prior to TRUS guided biopsy of the prostate in decreasing post biopsy infectious complications. Materials and Methods Between December 2016 and September 2017, 50 men were prospectively randomized to povidone iodine rectal cleansing (50) or no cleansing (50) before transrectal ultrasound guided prostate biopsy. Rectal swab cultures, urinalaysis, urine cultures, total leukocytic count and CRP were obtained before transrectal ultrasound guided prostate biopsy. Patients received ciprofloxacin prophylaxis and attended at 1 week follow up visit. Urinalaysis, urine cultures, total leukocytic count and CRP were obtained at follow up visit and asked about fever, UTI symptoms and examined for prostatitis and epididymo-orchitis. Results Infectious complications were observed in 5 (10%) patients, including 2 (8%) in the treatment group and 3 (12%) in the control group (p = 0.0001). No cases of sepsis were recorded. Mean increase of CRP was higher in control group (P = 0.011). 17 patients among study population had Ciprofloxacin resistant rectal organisms on rectal swab cultures (34%). Conclusion Usage of pre TRUS-Bx intrarectal povidone iodine suppository together with standard antibiotic prophylaxis with ciprofloxacin helps decrease post procedure infectious complications and proved to decrease incidence of infection among patients having ciprofloxacin resistant rectal organisms.