Infective complications in patients after transrectal ultrasound-guided prostate biopsy and the role of ciprofloxacin resistant Escherichia coli colonization in rectal flora

Abstract

Objective: In the present study, we aimed to invastigate the ciprofloxacin resistance in rectal flora of the patients undergoing prostate biopsy in our department. Additionally, the possible effects of the presence of ciprofloxacin resistant bacteria in faecal flora on the risk of infective complications after the procedure as well as the effect of antibiotic prophylaxis on such infectious complications have been evaluated. Material and methods:A total of 142 patients undergoing transrectal ultrasound-guided prostate biopsy were included into the study program. Rectal swab samples were taken from all patients prior to biopsy. The presence of complications have been evaluated after a week following the biopsy procedure. Patients with fever were also evaluated. The possible correlation between the presence of ciprofloxacin-resistant bacteria in faecal flora and the risk of urinary tract infection development and the other complications were evaluated.Results: E. coli bacteria were present in all cultures of rectal swab samples obtained from 142 patients prior to prostate biopsy. Of all these patients, while ciprofloxacin-resistant E. coli (CR E. coli) grew in 76 (53.5%) patients; ciprofloxacin susceptible E. coli (CS E. coli) was obtained in 66 (46.5%) patients. In 16 patients (11.3%), infectious complications were observed. While the infective complications were present in the 14.5% of patients with CR E. coli; they were present in the 7.6% of patients with CS E. coli (p= 0.295). High fever was observed in nine patients (6.3%). Of these nine patients, although six had CR E. coli growth as detected during culture sensitivity tests; three had CS E. coli growth in their rectal swab culture tests. Sepsis was observed in three (2.1%) of these patients with high fever. Ciprofloxacin-resistant E. coli grew in all of the rectal swab cultures obtained from these patients with sepsis. Conclusion:In the light of our findings we may say that, it will be appropriate to reconsider the ciprofloxacin prophylaxis and prefer to use other prophylactic agents for a certain period of time in populations with higher rates of resistance to this medical agent. Furthermore, it will be appropriate again to obtain rectal swab specimens for culture tests before biopsy procedure in order to perform targeted prophylaxis according to the culture antibiogram test results. This approach will enable us to evaluate the cost-effectiveness of the procedure in detail.

Comparison of Ciprofloxacin with a Combination of Cefixime-Clavulanic Acid Treatment in the Prophylaxis of Transrectal Prostate Biopsy

“…In a recent study, ciprofloxacin-resistant E. coli was detected in 53.5% of culture samples taken from rectal swabs before biopsy and resistant E. coli was observed in six of nine patients with high fever. Therefore, the authors stated that the antibiotic regimens should be amended (27) .…”

Elastography in prostate gland imaging and prostate cancer detection

“…Precisely targeted specimens from the appropriate cancerous foci should reduce the number of cores needed to diagnose. Furthermore, elastography might also decrease the number of biopsies per se and related complications [31]. Carneiro et al showed that a higher number of TRUS biopsy cores (>12) was associated with a higher risk of haemorrhage and perioperative complications during robotic-assisted radical prostatectomy [32].…”

Evaluation of patients with urinary tract infection after transrectal ultrasound guided prostate biopsy

“…The main source of urological infections after the biopsy is contamination and inoculation from rectal flora. Most patients scheduled for biopsy have a history of recurrent quinolone use [4] . Therefore, it is not surprising that the quinolone resistance of uropathogens is increased.…”