Non-antibiotic strategies for the prevention of infectious complications following prostate biopsy: A Systematic Review and Meta-analysis

Benjamin Pradere, Rajan Veeratterapillay, Konstantinos Dimitropoulos, Yuhong Yuan, Muhammad Imran Omar, Steven MacLennan, Tommaso Cai, Franck Bruyère, Riccardo Bartoletti, Bela Köves, Florian Wagenlehner, Gernot Bonkat, Adrian Pilatz* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose:To identify which non-antibiotic strategies could reduce the risk of infectious complications following prostate biopsy.Materials and Methods:We performed a literature search on MEDLINE, Embase, and Cochrane Database for randomized controlled trials (RCTs) (Inception to May 2020) assessing non-antibiotic interventions in prostate biopsy. Primary outcome was pooled infectious complications (fever, sepsis and symptomatic UTI) and secondary outcome was hospitalization. Cochrane risk of bias tool and GRADE approach were used to assess the bias and the certainty of evidence. Protocol was registered with PROSPERO (CRD42015026354).Results:90 RCTs (16,941 participants) were included in the analysis with 83 RCTs being categorized into one of ten different interventions. Transperineal biopsy was associated with significantly reduced infectious complications as compared to transrectal biopsy (RR 0·55, 95% CI 0·33- 0·92, p=0·02, I²=0%, participants=1330, studies=7). Rectal preparation with povidone-iodine was also shown to reduce infectious complications (RR 0·50, 95% CI 0·38-0·65, p<0·000001, I²=27%, participants=1686, studies=8) as well as hospitalization (RR 0·38, 95% CI 0·21-0·69,65 p=0·002, I²=0%, participants=620; studies=4). We found no difference in infectious complications/hospitalization for six other interventions: number of biopsy cores, periprostatic nerve block (PPNB), number of injections for PPNB, needle guide type, needle type, and rectal preparation with enema. In two interventions (needle diameter, rectal preparation with chlorhexidine) meta-analysis was not possible. Finally, seven studies had unique interventions. The certainty of evidence was rated as low/very low for all interventions.Conclusions:Transperineal biopsy significantly reduces infectious complications compared to transrectal biopsy and should therefore be preferred. If transrectal biopsy is performed, rectal preparation with povidone-iodine is highly recommended. The other investigated non-antibiotic strategies did not significantly influence infection and hospitalization after prostate biopsy
Original languageEnglish
JournalJournal of Urology
Early online date7 Oct 2020
DOIs
Publication statusE-pub ahead of print - 7 Oct 2020

Keywords

  • prostate bipsy
  • infection
  • prophylaxis

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    Pradere, B., Veeratterapillay, R., Dimitropoulos, K., Yuan, Y., Omar, M. I., MacLennan, S., Cai, T., Bruyère, F., Bartoletti, R., Köves, B., Wagenlehner, F., Bonkat, G., & Pilatz, A. (2020). Non-antibiotic strategies for the prevention of infectious complications following prostate biopsy: A Systematic Review and Meta-analysis. Journal of Urology. https://doi.org/10.1097/JU.0000000000001399