Sepsis Due to Fluoroquinolone-resistant Escherichia coli After Transrectal Ultrasound-guided Prostate Needle Biopsy

Young, Jennifer L.; Liss, Michael A.; Szabo, Richard J.

doi:10.1016/j.urology.2008.12.078

Cited by 60 publications

(64 citation statements)

References 25 publications

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“…Infectious complications from the prostate biopsy, which include urinary tract infections, prostatitis, and sepsis, have increased substantially every year (3,5,6,10,12,15). The most common organism responsible for these infectious complications is Escherichia coli (3,6,15). It is proposed that the resistant organisms are introduced into the bladder and bloodstream from the rectum during the biopsy procedure.…”

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confidence: 99%

Detection of Fluoroquinolone-Resistant Organisms from Rectal Swabs by Use of Selective Media Prior to a Transrectal Prostate Biopsy

2011

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Detection of Fluoroquinolone-Resistant Organisms from Rectal Swabs by Use of Selective Media Prior to a Transrectal Prostate Biopsy

2011

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“…3,4 Reports of fluoroquinolone resistance rates range from 1.2% to 23%, with rates reportedly higher in centres outside North America. 5 Nosocomial exposure and duration of the exposure to fluoroquinolones appear to be related to the incidence of resistance. [5][6][7] With good tissue penetration and randomized trials supporting its benefit, ciprofloxacin is our choice of prophylactic agent for TRUS-guided prostate biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…5 Nosocomial exposure and duration of the exposure to fluoroquinolones appear to be related to the incidence of resistance. [5][6][7] With good tissue penetration and randomized trials supporting its benefit, ciprofloxacin is our choice of prophylactic agent for TRUS-guided prostate biopsy. 8,9 No difference between a prophylactic single dose administration and a 3-day course has been noted, but these studies are likely underpowered.…”

Section: Discussionmentioning

confidence: 99%

“…11 Alternative choices to attempt to cover the common organisms E. coli, K. pneumoniae, P. aeruginosa and Enterococcus include another fluoroquinolone, a second or third generation cephalosporin or gentamicin. 5,12 There is no good evidence supporting the use of metronidazole. 12 Significant rectal bleeding has been reported at an incidence of 0.1% to 1%.…”

Section: Discussionmentioning

confidence: 99%

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Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

Toren

Razik

Trachtenberg

2013

CUAJ

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We report 2 cases of catastrophic complications following routine transrectal ultrasound guided prostate biopsy. The first patient incurred near-fatal septic shock due to multi-resistant Escherichia coli. Due to the severity of his shock, he developed bilateral leg gangrene requiring amputations. The second patient incurred significant hemorrhage eventually requiring an emergent general anesthesia and surgical management to control hemorrhage after other measures failed. While rare events, these reports emphasize the caution needed for physicians who routinely order prostate biopsies.Can Urol Assoc J 2010;4(1):E12-E14 Case 1A 63-year-old diabetic underwent transrectal ultrasound (TRUS)-guided prostate biopsy for an elevated PSA of 5.7 ng/mL and no findings on digital rectal examination (DRE). His past medical history included coronary bypass surgery, dyslipidemia and previous hospital admission for bronchitis. He smoked half a pack of cigarettes per day for 25 years.The day prior to his biopsy, he was initiated on ciprofloxacin 500 mg orally, 2 times a day. The night after his biopsy, he presented to the emergency room with a fever, chills, pain and breathlessness. He appeared septic, with a systolic blood pressure of 75 mmHg, temperature 39º C. Initial white blood count (WBC) was 1.1, with a critically low neutrophil count of 0.44. He was given fluids, ceftriaxone and flagyl in the emergency room. Subsequently, he was transferred to the intensive care unit (ICU) and started on ionotropes and empiric meropenem. He developed hypoxia and was intubated and sedated.During the first 4 days of admission, he continued to be unstable and hypotensive requiring ionotropic support and developing shock liver and renal failure. Solucortef and caspofungin were started; he also received a dose of amikacin. His WBC peaked at 42 on the fourth day of admission. Platelets remained very low at 21 and his international normalized ratio (INR) increased from normal to 2.13. Multi-resistant Escherichia coli was cultured from his blood and was initially only sensitive to amikacin, but eventually also found to be sensitive to meropenem.Against expectations, he survived and slowly recovered. A tracheostomy was performed, and he was eventually weaned off ventilation. As a result of his severe sepsis, he developed bilateral feet gangrene requiring bilateral below knee amputations. Further, he incurred ototoxicity requiring hearing aids. His thrombocytopenia, renal and liver failure resolved over time. He was in the ICU for a total of 46 days and in hospital for 85 days.His prostate biopsy did not show any evidence of malignancy. Case 2A 65-year-old pediatrician was sent for a TRUS biopsy of the prostate for a prostate-specific antigen (PSA) of 10.56 mg/L and a suspicious DRE. His medical history included coronary artery disease with previous coronary artery bypass grafting, hypertension and hypercholesterolemia. He had a mitral valve annuloplasty for mitral regurgitation. He experienced bleeding at the biopsy site immediately after ...

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“…Transrectal ultrasonography (TRUS) guided prostate needle biopsy is a standard procedure that has been performed since the 1980's in urology to diagnose and stage prostate cancer [1]. With the increased use of TRUS guided prostate biopsy, accompanying complications have also risen [2].…”

Section: Introductionmentioning

confidence: 99%

The comparison of the influence between two different bowel preparation methods on sepsis after prostate biopsies

Yıldırım¹,

Badem²,

Cavis³

et al. 2015

CEJU

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Introduction Transrectal ultrasonography (TRUS) guided prostate needle biopsy has been performed to diagnose and stage prostate cancer for many years. There are many different bowel preparation protocols to diminish the infectious complications, but there is no standardized consensus among urologists. Therefore, we aimed to assess two different bowel preparation methods on the rate of infectious complications in patients who underwent TRUS-guided prostate biopsy. Material and methods A total of 387 cases of TRUS-guided prostate biopsy were included in this retrospective study. All patients received antibiotic prophylaxis with ciprofloxacin (500 mg) twice a day orally for 7 days starting on the day before the biopsy. The patients were divided into two groups according to the bowel preparation method used. Patients (Group 1, n = 164) only received self-administrated phosphate enema) on the morning of the prostate biopsy. Other patients (Group 2, n = 223) received sennasoid a-b laxatives the night before the prostate biopsy. Infectious complications were classified as sepsis, fever (greater than 38°C) without sepsis, and other clinical infections. Results Major complications developed in 14 cases (3.8%), including 3 cases (0.8%) of urinary retention, and 11 (3%) infectious complications, all of which were sepsis. There were 3 and 8 cases of urosepsis in Group 1 and Group 2, respectively. There were no statistically significant differences between both Groups regarding to the rates of urosepsis (p = 0.358). Conclusions Despite both methods of bowel preparation, sodium phosphate enema or sennasoid a-b calcium laxatives, before TRUS-guided prostate biopsy have similar effect on the rate of urosepsis, so both methods of bowel preparation can be safely used.

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Sepsis Due to Fluoroquinolone-resistant Escherichia coli After Transrectal Ultrasound-guided Prostate Needle Biopsy

Cited by 60 publications

References 25 publications

Detection of Fluoroquinolone-Resistant Organisms from Rectal Swabs by Use of Selective Media Prior to a Transrectal Prostate Biopsy

Detection of Fluoroquinolone-Resistant Organisms from Rectal Swabs by Use of Selective Media Prior to a Transrectal Prostate Biopsy

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies

The comparison of the influence between two different bowel preparation methods on sepsis after prostate biopsies

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