The impact of povidone iodine rectal preparation in reducing rectal microorganism colony counts prior to prostate biopsy. A systematic review

Abstract

Aim: The aim of this study was to evaluate available evidence assessing the effect of peri-procedural povidone-iodine rectal preparation (PIRP) on the overall bacterial colonization of the rectum in men undergoing transrectal ultrasound-guided prostate biopsy (TRUSB) based on pre-and post-procedural rectal swab culture results. Methods: We performed a systematic review from January 2000-September 2017 sourced from electronic databases (Cochrane CENTRAL, MEDLINE, and EMBASE) using the terms "rectum sterilization" or "rectal cleansing" or "povidone-iodine" or "iodophor" or "povidone" or "betadine" and "transrectal" and "prostate biopsy" and manually evaluated for those specifically assessing bacterial colony counts pre-and post-PIRP. Findings: Two prospective and one retrospective cohort studies were identified that satisfied study requirements representing 547 patients in total. All patients assessed received both PIRP as well as stand care empiric antibiotic prophylaxis regimes prior to biopsy. All data demonstrated significant reductions in rectal swab colony counts observed post PIRP with a mean reduction of 97.8% seen in post procedural colony counts. On average colony counts pre PIRP were found to be 2.66 9 105 CFU/ml, with a reduction to an average of 4.3 9 103 CFU/ml post PIRP. These in vitro data corresponded to a relative almost four fold relative (RRR 3.77, 95% CI 0.99-14.40) and 2% absolute (ARR 0.02, 95% CI 0-0.03) reduction in postbiopsy infectious complications among statistically homogeneous effect sizes. Conclusion: Overall the available evidence demonstrates a dramatic reduction in rectal microorganism colony count post PIRP. Such findings lend support to the routine use of local therapies such as povidone iodine in prevention of post TRUSB related infectious complications. Further analysis is required to determine the impact of PIRP on overall infectious complications related to fluoroquinolone resistant pathogens.L6213521812018-03-27 <br />