Fluoroquinolone Resistance in the Rectal Carriage of Men in an Active Surveillance Cohort: Longitudinal Analysis

Abstract

Purpose Rectal swabs can identify men with fluoroquinolone resistant bacteria and decrease the infection rate after transrectal ultrasound guided prostate biopsy by targeted antimicrobial prophylaxis. We evaluated the rate of fluoroquinolone resistance in an active surveillance cohort with attention to factors associated with resistance and changes in resistance with time. Materials and Methods We evaluated 416 men with prostate cancer on active surveillance who underwent rectal swabs to assess the rate of fluoroquinolone resistance compared to that in men undergoing diagnostic transrectal ultrasound guided prostate biopsy. The chi-square test and Student t-test were used to compare categorical and continuous variables, respectively. Poisson regression analysis was used for multivariate analysis. Results On the initial swab fluoroquinolone resistance was found in 95 of 416 men (22.8%) on active surveillance compared to 54 of 221 (24.4%) in the diagnostic biopsy cohort (p = 0.675). Diabetes was found in 4.0% of the fluoroquinolone sensitive group vs 14.7% of the resistant group (p <0.001). Biopsy history was not associated with resistance. Of those with a resistant first swab 62.9% had a resistant second swab and 88.9% of those with 2 resistant swabs showed resistance on the third swab. Of men with a sensitive first swab 10.6% showed resistance on the second swab and 10.6% of those with 2 sensitive swabs had resistant third swabs. Conclusions One of 4 men who present for surveillance and diagnostic trans-rectal ultrasound guided prostate biopsy have rectal flora resistant to fluooquinolone. Resistance is significantly associated with diabetes but the number of prior biopsies is not. Men with fluoroquinolone resistant flora tend to remain resistant with time.

Prostate Biopsy-related Infection: A Systematic Review of Risk Factors, Prevention Strategies, and Management Approaches

“…Any potential risk is concerning in this context, with a retrospective analysis reported increased odds of an infection (OR 1.33, 95%CI 1.01 -1.74) for every previous biopsy in 591 consecutive men undergoing TRUBP 77 . Repeat biopsy has been reported to be a risk factor for colonisation with resistant E. coli strains 78 , with a progressive increase reported for each biopsy undertaken 79 . Post-biopsy complications have been reported to reduce rates of repeat biopsy in men undergoing active surveillance 80 .…”

Prostate Biopsy: Which Technique for Which Results at Lom&#233; University Hospital in 2017?

“…Infectious complications were particularly common in our series despite antibi- had been taken in advance, but diabetes is currently considered to be one of the risk factors for quinolone resistance [12]. Antibiotic prophylaxis adapted to the result of rectal swab sampling would reduce the risk of infection [13].…”

Transrectal prostate biopsy sepsis rate following reduced quinolone antibiotic prophylaxis from six doses to single dose

“…This rise in rates of TRPB‐related infection has been paralleled with the dramatic increase in fluoroquinolone‐resistant organisms . Recent studies have reported that up to one‐fourth of men undergoing prostate biopsy are colonized with rectal flora demonstrating fluoroquinolone resistance . It is therefore not surprising that higher rates of infection have been attributed to increasing antibiotic resistance and in particular increasing resistance to fluoroquinolones.…”