Reduction in Bacteremia Rates after Rectum Sterilization before Transrectal, Ultrasound-Guided Prostate Biopsy: A Randomized Controlled Trial
Panupong Kanjanawongdeengam MD*, Wit Viseshsindh MD*, Pitak Santanirand PhD*, Prapapan Prathombutr RN*, Supannee Nilkulwattana RN*
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : To determine the efficacy of rectum sterilization before TRUS guided prostate biopsy in order to
decrease bacteremia rate and sepsis complication.
Material and Method: From August 2008 to March 2009, 100 volunteers who had an indication for prostate
biopsy were recruited into the present study in a randomized controlled trial. The present study was approved
by the Ethics Committee on Human Experimentation of Ramathibodi Hospital Faculty of Medicine, Mahidol
University. The volunteers received unison enema one day before and Ciprofloxacin 500 mg 0.5-1 hr before the
procedure. These 100 volunteers were divided into two groups; 50 were randomly assigned in the group of
rectum cleaning with 10% povidone-iodine, whereas the other 50 volunteers were placed in the control
group. Twelve cores of TRUS guided prostate biopsy were performed. After the procedure, peripheral blood
samples were taken for cultures for aerobic and anaerobic bacteria. A clinical follow-up at 48-72 hrs after the
procedure was done via telephone.
Results : Hemocultures were positive for 9 cases in the rectum cleaning group and 2 cases in the control group
(p = 0.025). Three volunteers (one in the rectum cleaning group and two in the control group) had a post-
operative fever but it spontaneously resolved. Two volunteers in the control group came back to the hospital
because of urinary tract infections and rectal bleeding. None of the volunteers had clinical sepsis or went to
other hospitals.
Conclusion : Sterilization of the rectum before TRUS guided prostate biopsy was found to reduce post-
operative bacteremia and might reduce clinical infections.
Keywords : Prostate, Biopsy, Bacteremia, Povidone-iodine
