Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis

You have accessJournal of UrologyReview Articles1 Mar 2021Nonantibiotic Strategies for the Prevention 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 PradereBenjamin Pradere Urologie, CHRU Bretonneau, Tours, France Université Francois Rabelais, PRES Centre Val de Loire, Equal study contribution. More articles by this author , VeeratterapillayRajan Veeratterapillay Freeman Hospital, Newcastle Upon Tyne, United Kingdom DimitropoulosKonstantinos Dimitropoulos Department Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, YuanYuhong Yuan Medicine, Division Gastroenterology, McMaster University, Hamilton, Canada OmarMuhammad Omar Guidelines Office, European Association Arnhem, The Netherlands MacLennanSteven MacLennan Academic Urology Unit, University CaiTommaso Cai Santa Chiara, Reg. Trento, Italy BruyèreFranck Bruyère BartolettiRiccardo Bartoletti Translational Research New Technologies, Pisa, KövesBela Köves South-Pest Teaching Budapest, Hungary WagenlehnerFlorian Wagenlehner Pediatric Andrology, Justus-Liebig-University Giessen, Germany BonkatGernot Bonkat Alta Uro AG, Merian Iselin Klinik, Center Biomechanics & Calorimetry, Basel, Switzerland PilatzAdrian †Correspondence: Justus Liebig Rudolf-Buchheim-Str. 7, 35392Giessen, telephone: +49-641-985-56362; FAX: +49-641-985-44577; E-mail Address: [email protected] View All Author Informationhttps://doi.org/10.1097/JU.0000000000001399AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract Purpose: We identify which nonantibiotic strategies could reduce risk infectious complications prostate biopsy. Materials Methods: performed a literature search on MEDLINE®, Embase® Cochrane Database randomized controlled trials (inception May 2020) assessing interventions in Primary outcome was pooled (fever, sepsis symptomatic urinary tract infection) secondary hospitalization. bias tool GRADE approach were used assess certainty evidence. protocol registered with PROSPERO (CRD42015026354). Results: total 90 (16,941 participants) included analysis, 83 being categorized into one 10 different interventions. Transperineal biopsy associated significantly reduced as compared transrectal (RR 0.55, 95% CI 0.33–0.92, p=0.02, I2=0%, 1,330 participants, 7 studies). Rectal preparation povidone-iodine also shown 0.50, 0.38–0.65, p <0.000001, I2=27%, 1,686 8 studies) well hospitalization 0.38, 0.21–0.69, p=0.002, 620 4 found no difference complications/hospitalization 6 other interventions, ie number cores, periprostatic nerve block, injections needle guide type, type rectal enema. In 2 (needle diameter, chlorhexidine) meta-analysis not possible. Finally, studies had unique evidence rated low/very low all Conclusions: reduces should therefore be preferred. If is performed, highly recommended. investigated did influence infection after Abbreviations Acronyms Grades Recommendation, Assessment, Development Evaluation MA MRI magnetic resonance imaging PPNB block RCT trial RoB 2019 more than 190,000 new cases cancer diagnosed States, causing 33,000 deaths.1 Worldwide, accounts significant proportion male mortality. diagnosis based biopsies patient evaluation an elevated specific antigen or abnormal digital examination there increasing role pre-biopsy MRI.2,3 Prostatic remains keystone management most commonly diagnostic procedure urology million per year.4 Therefore, many efforts been made prevent account major adverse events up 7% infections 3.1% depending antibiotic prophylaxis regimens.3 Even if recommended every guideline, incidence negligible its prevention utmost importance.2,3 addition, both induction resistance through use antibiotics side effects must considered.5 Post-biopsy over last few years.6,7 Thus, such targeted swab culture augmented applying 1 introduced complications.8,9 comprehensive we recently compiled various prophylaxis.10 addition aspects modalities techniques view minimizing events. Among them, route, enema, cores suggested potential factors risk.11,12 Nevertheless, systematic analysis available evaluating technical reducing post-biopsy infections. aim our review investigate whether what extent any Methods Evidence Acquisition followed PRISMA (Preferred Reporting Items Reviews Meta-Analysis) guidance Handbook reviews interventions.13,14 at detailed PICO (Population, Intervention, Comparison Outcomes) provided supplementary Appendix (https://www.jurology.com). Literature Search Medline, Embase, LILACS, CENTRAL, databases ClinicalTrial.gov searched (last 27, 2020). grey opengrey.eu oclc.org. Potentially eligible identified searching reference lists trials, reviews, health technology assessment reports (YY). There date language restrictions. order avoid publication bias, abstracts characterized RCTs, but published manuscripts yet available, meta-analysis, funnel plots involving studies. strategy Types Outcome Measures Pooled (calculated summing types reported ie, fever, sepsis, infection). This chosen since investigating complications, distinction between severe (eg sepsis) mild cystitis) detail (supplementary table 1, https://www.jurology.com). Secondary Hospitalization due complications. Data Collection Analysis screening, full-text data extraction independently reviewers (AP, BP RV). For each disagreement, another reviewer (MIO, SM) consulted. authors contacted provide missing information necessary. Eight nonEnglish evaluated corresponding languages members team appropriate skills (4×Chinese: YY; 1×French: BP, FB; 1×Spanish: AP, BP; 2×Turkish: Mete Cek, former EAU Guideline panel member). One Japanese article Korean translated English professional translators. RCTs that so far only abstracts. assessed (RV, KD), using tool.14,15 Any disagreements resolved via discussion consultation SM). comparison SM).14 Statistical Manager, version 5.3. fixed model calculate estimates treatment across similar their confidence intervals. ratio dichotomous outcomes. heterogeneity visually inspecting forest standard chi-square test significance level α=0.1. considered I2 statistic, quantifies inconsistency impact meta-analysis. Where heterogeneity, attempted determine possible reasons examining individual trial, subgroup characteristics, random model.14 Results Characteristics Included Studies 3,111 citations, 284 selected screening. Reasons exclusion are 3, inclusion process graphically illustrated diagram (fig. 1). characteristics 3 Of while Sensitivity analyses showed changes occurred without full-text. Figure 1. Preferred Meta-Analyses flowchart. Risk Bias Assessment figure 2. It noticeable majority unclear regarding sequence generation, allocation concealment blinding assessment. Furthermore, conducted patients personnel, certainly intervention. plot from (PPNB) asymmetry 4, A, summary according judgment item included. B, graph presented percentage Study Heterogeneity statistic 0% except Intervention (povidone-iodine), where it 27%. Since values changed marginally when effect models end points, throughout. mainly downgraded design, imprecision 5, 1: Impact Biopsy Route including route lower transperineal (22 among 673 men) (37 657 men; RR studies; certainty; fig. 3). 3. M-H, Mantel-Haenszel method. 685 patients. While hospitalizations necessary 346 group, out 339 undergoing statistical 0.09–1.61, very 2: Number Cores 11 2,626 men approach. 38 1,320 47 those 1,306 extended cores. 0.80, 0.53–1.22, 2,230 9 4). 4. Note: Emilozzi 2004 biopsy, 5 case 415 411 scheme group. 0.34, 0.05–2.13, 306 2, 3: Periprostatic Nerve Block Pain during 41 outcomes 5,540 61 2,633 73 2,907 block/control. 1.07, 0.77–1.48, 3,857 26 5). 5. Effect these studies, 14 13 971 15 1,128 group PPNB. 1.13, 0.59–2.16, 1,469 4: Injections Six applied 459 468 statistically 1.30, 0.35–4.76, 478 Two hospitalized 147 153 1.05, 0.15–7.32, 300 5: Disposable Needle Guides disposable guides reusable 253 113 22 140 guides. 0.51, 0.24–1.06, 6, Both recorded 0.17–1.74, 6: Type Only coaxial versus noncoaxial revealed 171 arm, needles. because zero study. occur 240 7: Diameter diameter 133 smaller 163 larger diameter. point 8: Preparation Enema Four enema 336 30 recorded, 335 control 31 reported. 0.96, 0.60–1.53, 671 6). 6. 231 0.44–2.86, 462 8, 9: Chlorhexidine chlorhexidine Although report separately intervention groups, primary cannot meta-analyzed double count 10: Povidone-Iodine Nine https://www.jurology.com) 1,936 930 131 1,006 0.38–0.65; 7). 7. 12 285 37 8). 8. Different Unique Interventions Seven disinfection, size, perineal cleansing) identified. those, time before vs (see Appendix). Appendix. Year Bingqian 2009 plus intraprostatic injection Bolat 2016 prostatic different* Costa formalin disinfection Lower De Nunzio 2015 full bowel different† Koc 2010 washing Taher 2014 Perineal cleansing Yu Time (before after) Significantly groups Raw authors; febrile infection: urosepsis 1; Discussion To knowledge first can possibly complements previous biopsy.10 current exploring prophylactic peri-prostatic preparation, used. best (low evidence) recent specifically head-to-head route. approaches debated years introduction accuracy.16–20 diagnostics unnecessary biopsies—and thus complications.21,22 Until now, methods proved real terms detection.23,24 designed detection rates criterion.25,26 Hence, size aforementioned calculated reveal differences infection, accuracy. older meta-analyses dependence difference.12,27 On hand, benefit protected postoperative fever 0.26, 0.14–0.28).28 However, limited they combined case-control counted duplicate, has groups.29,30 largest (165 162,577 patients) standardized prevalence 0.8% 0.1% 1.1% 0.9%, respectively.31 These surprising, reinforce classical principle surgical choose lowest contamination category rate complications.32 Our confirmed important aspect 0.33–0.92). Despite logistic challenges attached widespread local anesthetic technique, findings support “TREXIT 2020” abandon biopsy.17 Another taken. Over years, increased improving passes repeatedly mucosa cylinders, would expect higher rate. Various cohort addressed able show cylinders obtained independent infections.33–35 shows infection. confirms guidelines recommend biopsies.2,3 context, question anesthesia sense arises. impressively contributes perioperative pain gel intrarectally/control.36–39 requires further passages rectum might distribution pathogens. Previous topic sporadically infections, never primarily infection.38,39 block. absolutely consistent taken discussed above, passage leads contaminated mucosa, several parameters needle. shape, nature advantage preventing ever detected.40–45 heterogenous practice planned some urologists chlorhexidine, applications, all. Here, prior 0.38–0.65), 0.21–0.69). fully line meta-analysis.11 advantages simple implementation daily largely cost procedure.46 clear recommendation guidelines,2 value still needs spread urologists.33 strengths that, 1) 2) restriction, 3) includes 4) limitations acknowledged. summed, (urinary detail, particularly underestimate done taking regimes account, measures, geographical origin considered. Conclusions regimens evidence, Whereas concerns rising effects, procedures favored practice. Acknowledgments Emma Smith Office assisted review, Robert Pickard (deceased), upon Kingdom, initiated review. References : Cancer statistics, 2020. CA J Clin 2020; 70: Google Scholar Cancer. Netherlands: 2019. An update American Urological white paper common related Urol 2017; 198: 329. Link, Eur 2013; 64: 876. biopsy-related factors, strategies, approaches. 104: 11. Antibiotic resistance, hospitalizations, mortality biopsy: Norwegian Patient Registry. World 38: 17. systematic, random, image-guided 71: 353. efficacious Int Nephrol 2016; 48: 1197. 9. effectiveness relative empiric ultrasound-guided 2018; 36: 1007. 10. 204: 224. Reducing povidone-iodine: 2014; 46: 1691. 12. cancer: sequential analysis. Oncotarget 23322. 13. reporting items meta-analyses: statement. PLoS Med 2009; e1000097. 14. Key steps conducting underpinning clinical guidelines: methodology association urology. 73: 290. 15. Collaboration's randomised trials. BMJ 2011; 343: d5928. 16. FUTURE trial: multicenter target negative biopsies. 2019; 75: 582. 2020”: why starts now. Dis 23: 62. 18. MRI-targeted prostate-cancer diagnosis. N Engl 378: 1767. 19. Use basis multiparametric biopsy-naive (MRI-FIRST): prospective, multicentre, paired Lancet Oncol 20: 100. 20. Head-to-head subsequent resonance-guided prostate-specific antigen: large prospective 570. 21. Improved biopsies: imaging-based triage pathway public teaching hospital. 371. 22. Multiparametric follow-up 4259 men. BJU 124: 775. 23. Prebiopsy 3T PSA, normal examination, Magn Reson Imaging 2015; 41: 1394. 24. Magnetic imaging-ultrasound fusion consecutive No reduction improved stratification. 194: 1601. 25. imaging-targeted System PSA >/=4 ng/mL: Transl Androl 741. 26. imaging, detecting 77: 78. 27. results Asian 2012; 14: 310. 28. Surg 17: 31. 29. Optimal initial comparing 12-core 2008; 191. 30. efficacy 11: 134. global burden Epidemiol Infect 144: 1784. 32. urological surgery, viewpoint. Antimicrob Agents 58. 33. Infective Global Prevalence Infections (GPIU) 2011, multinational multicentre 63: 521. 34. Clinical importance regimen single center nine thousand four hundred eighty-seven cases. 19: 704. 35. Is predict serious complication biopsy?Urol 2010; 84: 395. 36. What effective ultrasonography-guided prostate? network Sci Rep 4901. 37. Effectiveness Cent 72: 121. 38. prostate. 2007; 127. 39. efficiency safety intrarectal topical 99: 373. 40. guide: possible?Int Braz 37: 79. 41. Does minimize biopsy?Urology 1024. 42. core method trial. CardioVascular Interv Radiol 39: 1736. 43. original 2003; 62: 689. 44. Sixteen gauge needles improve specimen quality 10-core 270. 45. 85: 147. 46. Povidone iodine reproducible means procedural Vis Exp 52670. © 2021 Education Research, Inc.FiguresReferencesRelatedDetailsCited ByUrkmez Demirel C, Altok M, Bathala T, Shapiro D Davis (2021) Freehand Grid-Based Anatomical Region Yield ComplicationsJournal VOL. 206, NO. (894-902), Online date: 1-Oct-2021. Volume 205Issue 3March 2021Page: 653-663Supplementary Advertisement Copyright Permissions© Inc.Keywordsprostatebiopsyinfectionsantibiotic prophylaxisAcknowledgmentsEmma review.MetricsAuthor Information Expand Loading ...