Yoshiki Hiyama1, Satoshi Takahashi2, Teruhisa Uehara3, Koji Ichihara4, Jiro Hashimoto5, Masanori Matsukawa6, Keisuke Taguchi7, Yasuharu Kunishima8,9, Hiroshi Hotta10, Masahiro Yanase9, Naoki Itoh11, Takaoki Hirose12, Koh Takeyama13, Hitoshi Tachiki14, Naoya Masumori1. 1. Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan. 2. Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan. 3. Department of Pediatric Urology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, Japan. 4. Department of Urology, Sapporo Central Hospital, Sapporo, Hokkaido, Japan. 5. Department of Urology, Kushiro Red Cross Hospital, Kushiro, Hokkaido, Japan. 6. Department of Urology, Takikawa Municipal Hospital, Takikawa, Hokkaido, Japan. 7. Department of Urology, Oji General Hospital, Tomakomai, Hokkaido, Japan. 8. Department of Urology, Obihiro Kyokai Hospital, Obihiro, Hokkaido, Japan. 9. Department of Urology, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan. 10. Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan. 11. Department of Urology, NTT East Sapporo Hospital, Sapporo, Hokkaido, Japan. 12. Department of Urology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Hokkaido, Japan. 13. Department of Urology, Hakodate National Hospital, Hakodate, Hokkaido, Japan. 14. Department of Urology, Steel Memorial Muroran Hospital, Muroran, Hokkaido, Japan.
Abstract
OBJECTIVES: To evaluate a regimen of targeted prophylaxis using rectal swab culture in patients undergoing transrectal ultrasound-guided prostate biopsy, and to investigate the characteristics of isolated fluoroquinolone-resistant Escherichia coli. METHODS: A prospective study was carried out from June 2013 through December 2014. Rectal swabs were cultured on agar plates containing either 2 μg/mL levofloxacin or 1 μg/mL sitafloxacin before transrectal ultrasound-guided prostate biopsy. Patients with susceptible organisms received levofloxacin or sitafloxacin, whereas those with resistant organisms received directed antimicrobial prophylaxis according to the results of the antimicrobial susceptibility test. Patients with infectious complications after prostate biopsy were identified, and characteristics of patients carrying fluoroquinolone-resistant Escherichia coli were analyzed. RESULTS: A total of 397 men underwent transrectal ultrasound-guided prostate biopsy. Of these patients, 74 (18.6%) had fluoroquinolone-resistant Escherichia coli. All fluoroquinolone-resistant Escherichia coli were susceptible to amikacin and meropenem. The risk factor for possible fluoroquinolone-resistant Escherichia coli was age of ≥73 years. Three (0.7%) patients who received appropriate antimicrobial prophylaxis had high-grade fever after the prostate biopsy. However, the pathogens were not fluoroquinolone-resistant Escherichia coli. CONCLUSIONS: Targeted antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided prostate biopsy can be associated with reducing severe infectious complications caused by fluoroquinolone-resistant Escherichia coli.
OBJECTIVES: To evaluate a regimen of targeted prophylaxis using rectal swab culture in patients undergoing transrectal ultrasound-guided prostate biopsy, and to investigate the characteristics of isolated fluoroquinolone-resistant Escherichia coli. METHODS: A prospective study was carried out from June 2013 through December 2014. Rectal swabs were cultured on agar plates containing either 2 μg/mL levofloxacin or 1 μg/mL sitafloxacin before transrectal ultrasound-guided prostate biopsy. Patients with susceptible organisms received levofloxacin or sitafloxacin, whereas those with resistant organisms received directed antimicrobial prophylaxis according to the results of the antimicrobial susceptibility test. Patients with infectious complications after prostate biopsy were identified, and characteristics of patients carrying fluoroquinolone-resistant Escherichia coli were analyzed. RESULTS: A total of 397 men underwent transrectal ultrasound-guided prostate biopsy. Of these patients, 74 (18.6%) had fluoroquinolone-resistant Escherichia coli. All fluoroquinolone-resistant Escherichia coli were susceptible to amikacin and meropenem. The risk factor for possible fluoroquinolone-resistant Escherichia coli was age of ≥73 years. Three (0.7%) patients who received appropriate antimicrobial prophylaxis had high-grade fever after the prostate biopsy. However, the pathogens were not fluoroquinolone-resistant Escherichia coli. CONCLUSIONS: Targeted antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided prostate biopsy can be associated with reducing severe infectious complications caused by fluoroquinolone-resistant Escherichia coli.