Fluoroquinolone Resistant Rectal Colonization Predicts Risk of Infectious Complications after Transrectal Prostate Biopsy

Abstract

Colonization of fluoroquinolone resistant organisms in the rectum identifies men at high risk for infection and subsequent hospitalization from prostate biopsy, especially in those with fluoroquinolone prophylaxis only.

Complications After Systematic, Random, and Image-guided Prostate Biopsy

“…Fluoroquinolone resistant organisms have been identified in 10-30% of patients undergoing rectal swab culture before PB 47,[49][50][51][52] , although rates of clinical infectious complications are lower at approximately 1-17.5% 7,45,46,48,[53][54][55][56][57] . Most infections are self-limiting and can be managed in the outpatient setting 7,45 .…”

“…Most infections are self-limiting and can be managed in the outpatient setting 7,45 . However, the incidence of more serious infectious complications requiring hospitalization has dramatically increased over time 2,15,[58][59][60] , with fluoroquinolone-resistant (FQR) Escherichia Coli as the most recognized risk factor 2,45,47,[49][50][51]53 . In this scenario, patients with biopsy-related bacterial acute prostatitis have a higher risk of sepsis when compared to those with spontaneous acute prostatitis, probably due to a different pathogenic bacterial strain among the two groups 61 .…”

“…Similar to previously reported studies, year of biopsy was an independent predictor of hospital admissions, with a 10% increase over time, likely related to the rising FQR. Fluoroquinolones, indeed, have been widely used as prophylaxis for TRUS-guided PB and for the treatment of urological infections for the last two decades but the number of FQR bacteria have been increased over time 47,49,53 . Other relevant studies 7,11,16,48,49,59,[68][69][70] reporting a similar hospitalization rate are summarized in Table 2.…”

“…Fluoroquinolones, indeed, have been widely used as prophylaxis for TRUS-guided PB and for the treatment of urological infections for the last two decades but the number of FQR bacteria have been increased over time 47,49,53 . Other relevant studies 7,11,16,48,49,59,[68][69][70] reporting a similar hospitalization rate are summarized in Table 2. A recent statewide study from the Michigan Urological Surgery Improvement Collaborative (MUSIC) group, reported a reduction in hospitalization rates for infectious complications from 1.19% to 0.56%, when adopting a specific protocol for antibiotic prophylaxis (by shifting from a monotherapy to a multi-drug prophylaxis or performing culture-directed prophylaxis) 51 .…”

Cutting to the Core of the Issue: Emerging Strategies To Reduce Prostate Biopsy-Related Infections

“…Rectal culture of over 2,600 men prior to prostate biopsy revealed that men who were colonized with fluoroquinolone-resistant E. coli were more likely to develop infection (6.6% versus 1.6%) and to require hospitalization (4.4% versus 0.9%) within 30 days of the procedure (22). Exposure to antimicrobial agents in the 6 months prior to biopsy has been identified in several studies as a risk factor for infection (23)(24)(25).…”