Prevalence of fluoroquinolone‐resistant rectal flora in patients undergoing transrectal ultrasound‐guided prostate needle biopsy: A prospective multicenter study

• Published in: International journal of urology Vol. 25; no. 3; pp. 278 - 283
• Main Authors: Chung, Ho Seok, Hwang, Eu Chang, Yu, Ho Song, Jung, Seung Il, Lee, Sun Ju, Lim, Dong Hoon, Cho, Won Jin, Choe, Hyun Sop, Lee, Seung‐Ju, Park, Sung Woon
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01-03-2018
• Subjects: Aged; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis - methods; Antibiotic resistance; Antibiotics; Bacteria; Biopsy; Biopsy, Needle - adverse effects; Biopsy, Needle - methods; Demography; Drug resistance; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli - isolation & purification; Escherichia coli - physiology; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Escherichia coli Infections - prevention & control; fluoroquinolone; Fluoroquinolones - pharmacology; Fluoroquinolones - therapeutic use; Gastrointestinal Microbiome - drug effects; Gastrointestinal Microbiome - physiology; Humans; infection; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - microbiology; Postoperative Complications - prevention & control; Prevalence; Prophylaxis; Prospective Studies; Prostate; Prostate - pathology; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Rectum; Rectum - microbiology; Rectum - surgery; Republic of Korea; Risk factors; Risk groups; Ultrasonic imaging; Ultrasonography, Interventional; Ultrasound; Republic of Korea; biopsy; infection; prostate; fluoroquinolone; Escherichia coli
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.13511

Objectives
To estimate the prevalence of fluoroquinolone‐resistant rectal flora in patients undergoing transrectal ultrasound‐guided prostate needle biopsy and to identify the high‐risk groups.
Methods
From January 2015 to March 2016, rectal swabs of 557 men who underwent transrectal ultrasound‐guided prostate needle biopsy were obtained from five institutions. Clinical variables, including demographics, rectal swab culture results and infectious complications, were evaluated. Univariable and multivariable analyses were used to identify the risk factors for fluoroquinolone resistance of rectal flora and infectious complications.
Results
The incidence of fluoroquinolone‐resistant and extended‐spectrum beta‐lactamase production was 48.1 and 11.8%, respectively. The most common fluoroquinolone‐resistant bacteria was Escherichia coli (81% of total fluoroquinolone‐resistant bacteria, 39% of total rectal flora), and 16 (2.9%) patients had infectious complications. Univariable and multivariable analysis of clinical parameters affecting fluoroquinolone resistance showed no factor associated with fluoroquinolone resistance of rectal flora. The clinical parameter related to infectious complications after prostate biopsy was a history of operation within 6 months (relative risk 6.60; 95% confidence interval 1.99–21.8, P = 0.002).
Conclusions
These findings suggest that a risk‐based approach by history taking cannot predict antibiotic resistance of rectal flora, and physicians should consider targeted antibiotic prophylaxis or extended antibiotic prophylaxis for Korean patients undergoing transrectal ultrasound‐guided prostate biopsy because of high antibiotic resistance of rectal flora.