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Title: Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy
Authors: Michael A. Liss
Stephen A. Taylor
Deepak Batura
Deborah Steensels
Methee Chayakulkeeree
Charlotte Soenens
G. Gopal Rao
Atreya Dash
Samuel Park
Nishant Patel
Jason Woo
Michelle McDonald
Unwanaobong Nseyo
Pooya Banapour
Stephen Unterberg
Thomas E. Ahlering
Hendrik Van Poppel
Kyoko Sakamoto
Joshua Fierer
Peter C. Black
University of California, San Diego
VA Medical Center
University of California, Irvine
Long Beach Healthcare System
The University of British Columbia
London North West Healthcare NHS Trust
KU Leuven– University Hospital Leuven
Mahidol University
University of Washington, Seattle
Keywords: Medicine
Issue Date: 1-Jan-2014
Citation: Journal of Urology. Vol.192, No.6 (2014), 1673-1678
Abstract: © 2014 American Urological Association Education and Research, Inc. Purpose Infection after transrectal prostate biopsy has become an increasing concern due to fluoroquinolone resistant bacteria. We determined whether colonization identified by rectal culture can identify men at high risk for post-transrectal prostate biopsy infection.Materials and Methods Six institutions provided retrospective data through a standardized, web based data entry form on patients undergoing transrectal prostate biopsy who had rectal culture performed. The primary outcome was any post-transrectal prostate biopsy infection and the secondary outcome was hospital admission 30 days after transrectal prostate biopsy. We used chi-square and logistic regression statistical analysis.Results A total of 2,673 men underwent rectal culture before transrectal prostate biopsy from January 1, 2007 to September 12, 2013. The prevalence of fluoroquinolone resistance was 20.5% (549 of 2,673). Fluoroquinolone resistant positive rectal cultures were associated with post-biopsy infection (6.6% vs 1.6%, p <0.001) and hospitalization (4.4% vs 0.9%, p <0.001). Fluoroquinolone resistant positive rectal culture increased the risk of infection (OR 3.98, 95% CI 2.37-6.71, p <0.001) and subsequent hospital admission (OR 4.77, 95% CI 2.50-9.10, p <0.001). If men only received fluoroquinolone prophylaxis, the infection and hospitalization proportion increased to 8.2% (28 of 343) and 6.1% (21 of 343), with OR 4.77 (95% CI 2.50-9.10, p <0.001) and 5.67 (95% CI 3.00-10.90, p <0.001), respectively. The most common fluoroquinolone resistant bacteria isolates were Escherichia coli (83.7%). Limitations include the retrospective study design, nonstandardized culture and interpretation of resistance methods.Conclusions Colonization of fluoroquinolone resistant organisms in the rectum identifies men at high risk for infection and subsequent hospitalization from prostate biopsy, especially in those with fluoroquinolone prophylaxis only.
ISSN: 15273792
Appears in Collections:Scopus 2011-2015

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