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Risk factors for and prophylactic effect of povidone-iodine rectal cleansing on infectious complications after prostate biopsy: a retrospective cohort study

  • Urology - Original Paper
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Abstract

Purpose

To evaluate the risk factors and efficacy of a povidone-iodine enema on infectious complications after transrectal ultrasound-guided prostate biopsy.

Methods

A total of 814 males who underwent transrectal ultrasound-guided prostate biopsy from January 2011 to December 2013 were evaluated retrospectively. Clinical variables, including demographics, prior antibiotic, or quinolone exposure, rectal swab culture results, povidone-iodine rectal cleansing, antibiotic prophylaxis, and infectious complications, were evaluated.

Results

Overall, 16 of 814 (2.0 %) patients developed infectious complications after prostate biopsy. Of the patients with infectious complications, five had fever, two had urinary tract infections, and nine had bacteremia or sepsis. Infectious complication rates were not significantly different between povidone-iodine rectal cleansing (n = 613) and no cleansing (n = 201) groups (1.5 vs. 3.5 %, p = 0.083). However, povidone-iodine rectal cleansing reduced severe infectious complications such as bacteremia and sepsis (0.3 vs. 3.5 %, p = 0.001). A rectal swab culture was performed in 552 patients, and extended-spectrum β-lactamase (ESBL)-producing and quinolone-resistant Escherichia coli were detected in 4.5 and 7.8 % of cultures, respectively. Quinolone and antibiotic exposure within 6 months prior to prostate biopsy were associated with quinolone resistance and ESBL positivity of rectal flora and infectious complications.

Conclusions

In the era of quinolone resistance, a povidone-iodine enema may reduce the infectious complication rate by reducing bacterial load. Quinolone exposure prior to prostate biopsy was a risk factor for antibiotic resistance to rectal flora and infectious complications.

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Acknowledgments

This study was financially supported by a Grant (2013-0707) Chonnam National University, Republic of Korea.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

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Authors and Affiliations

  1. Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Gwangju, Hwasun, 519-763, Republic of Korea

    Eu Chang Hwang, Seung Il Jung, Young Ho Seo, Se Heon Jeong, Dong Deuk Kwon & Kwangsung Park

  2. Departments of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea

    Jin Woong Kim

Authors
  1. Eu Chang Hwang
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  2. Seung Il Jung
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  3. Young Ho Seo
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  4. Se Heon Jeong
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  6. Kwangsung Park
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  7. Jin Woong Kim
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Corresponding author

Correspondence to Seung Il Jung.

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Hwang, E.C., Jung, S.I., Seo, Y.H. et al. Risk factors for and prophylactic effect of povidone-iodine rectal cleansing on infectious complications after prostate biopsy: a retrospective cohort study. Int Urol Nephrol 47, 595–601 (2015). https://doi.org/10.1007/s11255-015-0931-2

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  • DOI: https://doi.org/10.1007/s11255-015-0931-2

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