Incidence and management of extended-spectrum beta-lactamase and quinolone-resistant Escherichia coli infections after prostate biopsy.

Abstract

OBJECTIVE: To provide an overview of the incidence, bacteriologic

characteristics, and antimicrobial resistance in acute prostatitis after

transrectal ultrasonography (TRUS)-guided prostate biopsy. MATERIALS AND METHODS:

We reviewed the medical records of 9568 patients who underwent TRUS-guided biopsy

between March 1995 and May 2013. These patients received oral quinolone and/or

cephalosporin and intramuscular aminoglycoside as antibiotic prophylaxis. In

patients with acute prostatitis, blood and urine cultures were obtained on

hospital admission. The incidences of acute prostatitis and antimicrobial

resistance were examined according to time period. RESULTS: A total of 11,345

cases of TRUS-guided biopsy were performed for 9568 patients. Acute prostatitis

developed in 103 patients (0.91%). In 63 patients, the causative organism was

isolated from blood and/or urine culture. The most frequent etiologic organism

was Escherichia coli, which was present in 47 of 49 patients (95.9%) in blood and

from 39 of 41 patients (95.1%) in urine. Extended-spectrum beta-lactamase

(ESBL)-producing E coli were detected continuously since 2008 and found in 10

patients (21.3%) in blood and 8 patients (20.5%) in urine. Forty-four patients

(93.6%) in blood and 36 patients (92.3%) in urine of the positive cultures and

all cases with ESBL-producing E coli infection showed resistance to quinolone.

ESBL-producing E coli were susceptible to imipenem, amikacin, and cefoxitin.

CONCLUSION: In the treatment of acute prostatitis after TRUS-guided biopsy,

quinolone is not an effective antimicrobial of choice. We should take into

account antimicrobial-resistant patterns because of the high prevalence of

quinolone resistance and emergence of an ESBL-producing strain.