Modification of Antimicrobial Prophylaxis Based on Rectal Culture Results to Prevent Fluoroquinolone-Resistant <i>Escherichia coli</i> Infections after Prostate Biopsy

Suwantarat, Nuntra; Dumford, Donald M.; Ponce-Terashima, Rafael; Kundrapu, Sirisha; Zabarsky, Trina F.; Zhu, Hui; Donskey, Curtis J.

doi:10.1086/671734

Cited by 31 publications

(37 citation statements)

References 10 publications

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“…The definition of PTBIC was similar in all studies. Studies by Taylor et al , Duplessis et al , Suwantarat et al , Aradas et al , Cook et al , and Trujillo et al recorded distinct clinical presentations, including fever >38.5 °C, UTI, pyelonephritis, bacteraemia, prostatitis, systemic inflammatory response syndrome, and sepsis. However, as Duplessis et al used retrospective data for their control group, they only reported cases of sepsis for this group.…”

Section: Resultsmentioning

confidence: 98%

The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography‐guided prostate biopsy in reducing infection rates: a systematic review

et al. 2016

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To compare the incidence of infective complications after transrectal ultrasonography (TRUS)-guided biopsy with either empirical fluoroquinolone or culture-based targeted antimicrobial prophylaxis, and the prevalence of fluoroquinolone resistance (FQ-R) in men undergoing prostate biopsy. A systematic review of the literature was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included studies of patients undergoing TRUS-guided biopsy that compared infective outcomes of those who received targeted antimicrobial therapy based on the results of preprocedural rectal swab cultures, with those receiving empiric fluoroquinolone antimicrobial prophylaxis. The prevalence of FQ-R was recorded as a secondary outcome measure. Studies with no control group were excluded. From 125 studies screened, nine studies (4 571 patients) met the inclusion criteria. All studies were of cohort design, and included a combination of retrospective and prospective data. Six studies included were undertaken in North America. The remaining studies were undertaken in Spain, Turkey and Columbia. Within these studies, 2 484 (54.3%) patients received empirical fluoroquinolone prophylaxis, whilst 2 087 (45.7%) patients had pre-biopsy rectal swabs and targeted antibiotics. The mean FQ-R was 22.8%. Post-biopsy infection and sepsis rates were significantly higher in groups given empirical prophylaxis (4.55% and 2.21%) compared with groups receiving targeted antibiotics (0.72% and 0.48%). Based on these results 27 men would need to receive targeted antibiotics to prevent one infective complication. Our systematic review suggests that targeted prophylactic antimicrobial therapy before TRUS-guided prostate biopsy is associated with lower rates of sepsis. We therefore recommend changing current pathways to adopt this measure.

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Section: Resultsmentioning

confidence: 98%

The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography‐guided prostate biopsy in reducing infection rates: a systematic review

et al. 2016

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“…In 2011, we documented through rectal swab screening that the prevalence of colonisation with FQ-resistant E. coli at our facility was 16%, whereas surprisingly it was only 1% for ESBL-producing E. coli [23]. Unfortunately, the standard prophylaxis for TRUBP used at our hospital, ciprofloxacin, may have contributed to select populations of FQ-resistant E. coli , which translocated to the prostate and bloodstream as the needle passed through the rectum.…”

Section: Resultsmentioning

confidence: 99%

“…Given the morbidity we observed from infectious complications after TRUBP, screening for colonisation with MDR and FQ-resistant E. coli and subsequent adjustment of antibiotic prophylaxis was implemented in LSCDVAMC. Through these measures, the rate of FQ-resistant E. coli infections following TRUBP has decreased significantly ( P < 0.05), from 4.3% (23/541) before the intervention to 1.6% (9/571) in the subsequent 18-month period [23]. We foresee that the advent of more sensitive and rapid diagnostic methods in the clinical setting will facilitate the early detection of certain MDR strains with defined virulence profiles, such as FQ- resistant E. coli ST131.…”

Section: Resultsmentioning

confidence: 99%

Infections caused by fluoroquinolone-resistant Escherichia coli following transrectal ultrasound-guided biopsy of the prostate

Suwantarat

Rudin

Marshall

et al. 2014

Journal of Global Antimicrobial Resistance

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An increase in the number of infections with fluoroquinolone (FQ)-resistant Escherichia coli following transrectal ultrasound-guided biopsy of the prostate (TRUBP) was observed in Louis Stokes Cleveland Department of Veterans Affairs Medical Center. This study investigated whether these infections were caused by a single strain of E. coli possessing distinct resistance and virulence determinants. Of 15 patients with urinary tract infection, 5 were complicated with bacteraemia and 1 with prostate abscess. Thirteen FQ-resistant isolates demonstrated mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC but did not contain plasmid-mediated quinolone resistance determinants; blaCTX-M and blaCMY as well as genes coding for extended-spectrum β-lactamases were also absent. Genes encoding aminoglycoside-modifying enzymes were discovered in an isolate that was gentamicin-resistant. The most prevalent sequence type (ST) was ST43 (n = 7), corresponding to ST131 in Achtman's multilocus sequence typing (MLST) scheme. These isolates (i) were distinguished as >95% similar by repetitive sequence-based PCR (rep-PCR), (ii) belonged to the virulent phylogenetic group B2 and (iii) contained plasmid types FIB, FIA and Frep. Several other strain types were present (ST2, ST27, ST30, ST44, ST472, ST494, ST511 and ST627). Non-ST43 isolates infected patients with more co-morbidities but contained similar virulence factors (kpsMTII, iutA, papAH/papC and sfa/focDE). In our hospital, E. coli isolates causing TRUBP-related infection are quite heterogeneous (ST131 and other ST types) and are part of phylogenetic groups containing multiple virulence factors.

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“…The secondary goal was to investigate whether fosfomycin could be a peroral alternative to ciprofloxacin in the case of FQ resistance. The use of rectal cultures (by rectal swabs) before TRPB to serve as a guide for targeted prophylaxis has been investigated before . However, to our knowledge, this is the first prospective randomized multicenter study in which the control group received standard antibiotic prophylaxis (ciprofloxacin) regardless of the result of the rectal swab, and the intervention group received targeted prophylaxis (fosfomycin) in the case of FQ resistance.…”

Section: Introductionmentioning

confidence: 99%

Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study

et al. 2018

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Objectives To investigate whether switching ciprofloxacin to fosfomycin in the case of fluoroquinolone‐resistant rectal bacteria influences the incidence of infectious complications after transrectal prostate biopsy. Methods From December 2015 until December 2017, patients undergoing prostate biopsy were randomly assigned to a control group or an intervention group in a prospective, open‐label fashion at three different centers. The presence of fluoroquinolone‐resistant organisms was detected by rectal swabs. Patients in the control group received ciprofloxacin. Patients in the intervention group received fosfomycin instead of ciprofloxacin in the case of fluoroquinolone‐resistant bacteria on rectal swab culture. The primary end‐point was the difference in occurrence of major (febrile) and minor (afebrile) infections between both groups. Results A total of 102 patients were randomized to the control group, and 102 patients to the intervention group. In the control group, nine complications occurred, of which five were major febrile complications. In the intervention group, six complications occurred, of which four were major febrile complications. The total number of complications (major and minor) did not differ between both groups (P = 0.59). A subgroup analysis of patients with fluoroquinolone‐resistant bacteria on rectal swab showed five complications in the control group and one complication in the intervention group (P = 0.09). Conclusions This represents the first prospective randomized study using rectal cultures for targeted antibiotic prophylaxis. Study findings show promising results for use of fosfomycin in patients with fluoroquinolone resistance.

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Modification of Antimicrobial Prophylaxis Based on Rectal Culture Results to Prevent Fluoroquinolone-Resistant Escherichia coli Infections after Prostate Biopsy

Cited by 31 publications

References 10 publications

The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography‐guided prostate biopsy in reducing infection rates: a systematic review

The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography‐guided prostate biopsy in reducing infection rates: a systematic review

Infections caused by fluoroquinolone-resistant Escherichia coli following transrectal ultrasound-guided biopsy of the prostate

Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study

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