Formalin disinfection of prostate biopsy needles may reduce post-biopsy infectious complications

Does Formalin Disinfection Reduce Bacterial Colonization of Biopsy Needle? A Prospective Study

OBJECTIVE

To investigate the efficacy of formalin disinfection of the needle tip in transrectal prostate biopsy (TRB) procedure to reduce infectious complications. The primary aim is to assess the impact of formalin on bacterial contamination of biopsy needle tips and its association with post-biopsy infective events.

MATERIALS AND METHODS

We have employed a bacterial culture-based observational cohort design in this study. Two groups, formalin disinfection and non-formalin group, both underwent systematic 12-core TRB. In the formalin group, the biopsy needle tip was immersed in 10% formalin solution after each core, while in the non-formalin group, no formalin solution immersion was used. The primary outcomes include bacterial growth on biopsy needle tips and post-biopsy infective events.

RESULTS

Formalin disinfection significantly reduced bacterial growth on needle tips (P <.001). The formalin group had no post-biopsy infections or sepsis, while the non-formalin group experienced a 7.5% infective event rate after TRB.

CONCLUSION

Formalin disinfection of biopsy needle tip significantly reduces bacterial growth on biopsy needle and urinary tract infectious complications developed secondary to TRB. Further multicenter randomized controlled studies with larger cohorts are warranted to validate and establish formalin disinfection as a routine practice in TRB procedures.

Nonantibiotic strategies to decrease the postbiopsy hospitalization rates because of infectious complications after transrectal prostate biopsy

OBJECTIVES

To compare the effect of biopsy needle disinfection with 10% formalin solution alone and with povidone-iodine rectal cleaning on preventing infectious complications requiring hospitalization.

METHODS

The data of 902 patients who underwent prostate biopsy by transrectal route were retrospectively analyzed. Inclusion criteria were prophylactic antibiotic use and negative urine culture before the biopsy. Three groups occurred according to the methods used during the biopsy procedure. In Group 1, 501 patients, biopsy needle disinfection was made using 10% formalin solution during the biopsy procedure. Group 2, 164 patients, applied only prophylactic antibiotics. Group 3, 237 patients, applied both 10% formalin disinfection of the biopsy needle and prebiopsy povidone-iodine rectal cleansing. Hospitalized patients because of infectious complications a month after the biopsy were our outcome measures.

RESULTS

Hospitalization rates because of biopsy-related infectious complications, according to Groups 1, 2, and 3, were 2.7%, 8.5%, and 0%, respectively. The best results were observed in Group 3 and the worst in Group 2.

CONCLUSIONS

The two nonantibiotic strategies, biopsy needle disinfection with formalin solution and rectal cleaning with povidone-iodine, look more effective when applied together. However, further prospective studies are required to confirm our analysis.

Dermatopathology Laboratory Green Initiatives

OBJECTIVES

Climate change and the accumulation of greenhouse gases pose challenges for humanity. The laboratory can reduce the environmental impact of routine operations.

METHODS

Our laboratory implemented several recycling initiatives in 2021, including shredding plastic and recycling 10% formalin, xylene, and reagent alcohols. Additional insulation has reduced electricity costs, and we have plans to derive 100% of our electricity from solar in 2022.

RESULTS

Recycling leads to decreases in reagent purchase by several hundred gallons. Our lab reduced its carbon footprint by a minimum of 68.52 tons, with an anticipated $43,000 savings in purchases and waste disposal during 2022.

CONCLUSIONS

Regardless of an individual's environmental consciousness, green initiatives have several tangible benefits. Recycling helps mitigate climate change and decrease the laboratory's carbon footprint. These measures also insulate the laboratory from supply shortages and lead to significant, tangible monetary savings.

Transrectal povidone-iodine efficiency in reducing infections occurring after transrectal ultrasound guided biopsy of the prostate

ABSTRACT

The present study aimed to compare infectious complications in men undergoing transrectal ultrasound-guided prostate biopsy (TRUS-Bx) with and without povidone-iodine transrectal injection using a gavage syringe.The records of 112 patients, who underwent TRUS-Bx between January 2016 and December 2019, were retrospectively reviewed. The biopsy indication was considered high prostate-specific antigen (PSA) level and/or suspicious digital rectal prostate examination findings. Patients' ages, underlying diseases, PSA levels, prostate volumes, pathologic results, and infectious complications after the biopsy were investigated. All the patients received 1500 mg of ciprofloxacin (750 mg twice a day) for 5 days, starting from the day before the procedure. Forty-seven (41.96%) patients received ciprofloxacin prophylaxis with povidone-iodine transrectal injection, while 65 (58.03%) only received ciprofloxacin prophylaxis. All the patients, who were readmitted to the hospital after the procedure, especially with a temperature of higher than 37.8°C, were detected. For the purposes of the study, the priority was placed on the emergence of the rate of febrile infectious complications. Differences in febrile infectious complications in patients, who received ciprofloxacin prophylaxis with transrectal povidone-iodine, and those, who received ciprofloxacin prophylaxis alone before TRUS-Bx, were studied.Febrile infectious complications developed in 10 cases (15.38%) in patients, who received ciprofloxacin antibiotics prophylaxis alone. In the povidone-iodine rectal disinfection group, there was only 1 case of febrile infectious complication (2%). There was no significant difference by clinicopathologic features, age, PSA level, and cancer detection rate between both groups (P > .05). Multivariate logistic regression analysis did not identify any patient subgroups at a significantly higher risk of infection after prostate biopsy. There was no significant side effect associated with povidone iodine.In addition to the use of prophylactic antibiotics, transrectal povidone-iodine was useful in reducing the febrile infection complications following TRUS-Bx.

Minimizing transrectal prostate biopsy-related infections; A prospective randomized trial of povidone-iodine intrarectal cleaning versus formalin needle disinfection

INTRODUCTION

Transrectal prostate biopsies are associated with post biopsy infection and sepsis. We compared the efficacy of povidone-iodine rectal disinfection versus formalin needle disinfection in preventing post biopsy infection among patients undergoing transrectal ultrasound-guided prostate biopsy.

METHODS

Patients scheduled to undergo ultrasound-guided transrectal prostate biopsy (n = 621) over 20 months were randomized into 2 groups to receive either povidone-iodine intrarectal disinfection or formalin disinfection of needle after each core. These were compared to assess which methodology better prevented postprocedure infection. Statistical analysis were used to identify independent factors promoting infections.

RESULTS

Two hundred and ninety-eight patients from povidone-iodine intrarectal disinfection were compared with 300 from formalin needle disinfection group. Formalin needle disinfection was associated with significantly more infections (P = 0.02). Escherichia coli was the dominant pathogen, with >50% of cases being quinolone resistant. Type of disinfection (P = 0.002), BMI (P = 0.001), chronic prostatitis (P = 0.002), and diabetes mellitus (P = 0.01) were independent predictors of infections. BMI at 28.95 kg/m2 provided the best predictive cut-off point for infections, irrespective of method of disinfection. Area under the curve for all these parameters together was 0.91.

CONCLUSIONS

We conclude that along with oral cephalosporin prophylaxis, povidone-iodine intrarectal disinfection is a superior to formalin needle disinfection alone in preventing post biopsy infection. Patients with BMI >28.95 kg/m2 should be considered at a higher risk for infections.

Update on techniques to prevent infections associated with prostate needle biopsy

PURPOSE OF REVIEW

Postbiopsy infections (PBIs) are among the most common complications associated with transrectal ultrasound-guided prostate biopsy (TRUSPB). This article discusses the pathogenesis of TRUSPB-associated infectious complications and reviews the most recent findings on techniques to prevent PBIs.

RECENT FINDINGS

Risk stratification is a powerful tool for identifying TRUSPB candidates whom warrant additional preventive measures. Bowel preparation with povidone-iodine-based enemas and needle disinfection with formalin solution are simple and attractive strategies, but their effectiveness needs to be thoroughly assessed. Antibiotic prophylaxis represents the mainstay for the prevention of PBIs: the prophylactic regimen must respect the principles of antimicrobial stewardship, and local antibiotic resistance patterns among uropathogens should always be considered. Augmented and targeted antibiotic prophylaxes are powerful options, but their role in current clinical practice has yet to be clarified. The transperineal approach has shown a near-zero rate of PBIs, and should therefore be considered for the highest-risk patients.

SUMMARY

Several procedures have been introduced to prevent TRUSPB-related infectious complication, but their utility and applicability in the clinical practice has yet to be elucidated. More robust evidence based on randomized control trials is needed to establish the efficacy of these tools in improving patient outcomes.

How to Biopsy: Transperineal Versus Transrectal, Saturation Versus Targeted, What's the Evidence?

Until recently, prostate biopsy for the detection of prostate cancer has been performed transrectally and in an untargeted sampling fashion. Consequently, the procedure has suffered a small but significant risk of severe morbidity through infection, and low diagnostic accuracy, with undergrading and missed diagnosis being common. MRI is revolutionizing prostate cancer diagnosis by improving detection accuracy via targeted biopsy. Transperineal biopsy is eradicating sepsis as a risk of prostate biopsy, while avoiding the need for broad-spectrum or combination prophylactic antibiotics. This article analyzes the data on the various current methods of performing prostate biopsy and recommends an optimal technique.