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Introduction:
In this study, we aimed to identify risk factors for the development of infectious complications after prostate biopsy and to investigate the role of intestinal colonization of bacteria that are resistant to prophylactic antibiotics.
Methodology:
A total of 168 patients who had undergone transrectal prostate biopsy (TRPB) under cip...
Contexts in source publication
Context 1
... of them (75%) had a history of using fluoroquinolones. In the univariate analysis, age over 65 years, presence of chronic renal disease, presence of diabetes, malignancy history, use of immune suppressive drugs, history of urological surgery, and detection of malignancy in prostate biopsy specimen were statistically insignificant risk factors (Table 2). Urolithiasis history, presence of permanent urinary catheterization, hospitalization history for more than 48 hours in the last year, and recent antibiotic usage increased UTI risk significantly after TRPB ( Table 2). ...
Context 2
... the univariate analysis, age over 65 years, presence of chronic renal disease, presence of diabetes, malignancy history, use of immune suppressive drugs, history of urological surgery, and detection of malignancy in prostate biopsy specimen were statistically insignificant risk factors (Table 2). Urolithiasis history, presence of permanent urinary catheterization, hospitalization history for more than 48 hours in the last year, and recent antibiotic usage increased UTI risk significantly after TRPB ( Table 2). The risk factors according to the microorganisms can be seen in table 3. ...
Context 3
... risk factors identified include underlying medical comorbidities (particularly diabetes mellitus) and recent hospitalization [10,12]. In our study, comorbidities such as chronic renal failure and diabetes mellitus were insignificant risk factors ( Table 2). Hospitalization of more than 48 hours' duration in the preceding year was noted as a risk factor in our study. ...
Citations
... Our results correlate well with the findings of other authors [10][11][12][13][14][15], suggesting the importance of the rectal bacterial flora and resistance to the administered prophylaxis. Although several studies have shown an association between the risk for post-TRUS-Bx UTI and the presence of ciprofloxacin-resistant E. coli in the rectal flora, the metric for resistance was not always defined or varied between studies [13,14]. ...
... The infection rate in this study is thus in the higher range, which may be since both UTI without SIRS and UTI with SIRS were included. Several studies have shown that the rate of infectious complications after TRUS-Bx is growing and is directly related to the increasing prevalence of FQ-resistant microorganisms [6,10,11,13]. Some studies have shown that use of FQ in the last 6 months prior to TRUS-Bx independently predict the presence of FQ-resistant faecal organisms [21,22]. ...
Background: Infection of the prostate gland following biopsy, usually with Escherichia coli, is a common complication, despite the use of antimicrobial prophylaxis. A fluoroquinolone (FQ) is commonly prescribed as prophylaxis. Worryingly, the rate of fluoroquinolone-resistant (FQ-R) E. coli species has been shown to be increasing.Objective: This study aimed to identify risk factors associated with infection after transrectal ultrasound-guided prostate biopsy (TRUS-Bx).Methods: This was a prospective study on patients undergoing TRUS-Bx in southeast Sweden. Prebiopsy rectal and urine cultures were obtained, and antimicrobial susceptibility and risk-group stratification were determined. Multivariate analyses were performed to identify independent risk factors for post-biopsy urinary tract infection (UTI) and FQ-R E. coli in the rectal flora.Results: In all, 283 patients were included, of whom 18 (6.4%) developed post-TRUS-Bx UTIs. Of these, 10 (3.5%) had an UTI without systemic inflammatory response syndrome (SIRS) and 8 (2.8%) had a UTI with SIRS. Being in the medium- or high-risk groups of infectious complications was not an independent risk factor for UTI with SIRS after TRUS-Bx, but low-level FQ-resistance (minimum inhibitory concentration (MIC): 0.125–0.25 mg/L) or FQ-resistance (MIC > 0.5 mg/L) among E. coli in the faecal flora was. Risk for SIRS increased in parallel with increasing degrees of FQ-resistance. Significant risk factor for harbouring FQ-R E.coli was travelling outside Europe within the previous 12 months.Conclusion: The predominant risk factor for UTI with SIRS after TRUS-Bx was FQ-R E. coli among the faecal flora. The difficulty in identifying this type of risk factor demonstrates a need for studies on the development of a general approach either with rectal swab culture for targeted prophylaxis, or prior rectal preparation with a bactericidal agent such as povidone-iodine before TRUS-Bx to reduce the risk of FQ-R E. coli-related infection.
... Aminoglycosides are commonly used as prophylaxis for TRUSB, often in an augmented manner for those at risk of FQ resistance [2]. While gentamicin resistance rates (48%) are higher than those for amikacin in isolates after TR biopsy [55], the additional benefit of using amikacin is controversial [2,56]. ...
Background
Prostate biopsy is a standard tool for diagnosing prostate cancer, with more than 4 million procedures performed worldwide each year. Infectious complications and economic burden are reportedly rising with continued use of trans-rectal ultrasound-guided biopsy, despite the transperineal approach being associated with less infectious complications.Objective and methodsIn this review, the contemporary literature on pathophysiology, epidemiology, risk factors, causative organisms and emerging approaches for prevention of infectious complications are outlined.ResultsManagement of infectious complications after TRUSB has caused significant financial burden on health systems. The most frequent causative agents of infectious complications after prostate biopsy are Gram-negative bacilli are particularly concerning in the era of antibiotic resistance. Increasing resistance to fluoroquinolones and beta-lactam antibiotics has complicated traditional preventive measures. Patient- and procedure-related risk factors, reported by individual studies, can contribute to infectious complications after prostate biopsy.Conclusions
Recent literature shows that the transrectal ultrasound-guided prostate biopsy results in higher infectious complication rate than the transperineal prostate biopsy. NAATs, recently introduced technique to detect FQr may detect all antibiotic-resistant rectal microbiota members—included MDRs—although the technique still has limitations and economical burdens. Transient solutions are escalating antibiotic prophylaxis and widening the indications for TPB.
... 8 Fluoroquinolones are the most widely used antibiotic prophylactic antimicrobial regimen for TRUS-PNB 8,9 and emergence and dissemination of antimicrobial resistant E. coli and in particular, fluoroquinolone-resistant strains have been a major challenge in patients undergoing TRUS-PNB. 10,11 In the patients experiencing infectious complications following TRUS-PNB, IED, including bacteremia, has been widely reported. [12][13][14][15] Yet, detailed information on IED epidemiology and its clinical characteristics in the context of TRUS-PNB performed in different clinical settings is currently lacking. ...
Purpose:
Extraintestinal pathogenic Escherichia coli (ExPEC) are a leading cause of invasive infections in adults. The study aimed to evaluate the incidence of microbiologically confirmed Invasive ExPEC disease (IED) in patients undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-PNB), O-serotype distribution and antibiotic resistance profiles of associated E. coli isolates.
Materials and methods:
Adult men (≥18 years) undergoing TRUS-PNB were enrolled. The TRUS-PNB procedure was performed according to local standard of care, including preferences of prophylactic antibiotics. Clinical and microbiological data were collected.
Results:
Of the 4951 patients (mean age: 66.9 years) enrolled, 4935 (99.7%) underwent TRUS-PNB (95.1% received prophylactic antibiotics); 98.9% completed the study. Overall incidence of IED was 0.67% (33/4935 patients; 95% CI: 0.46-0.94); highest incidence was in US (0.97%, 14/1446 95% CI: 0.53-1.62). Prevalence of the 10 selected O-serotypes O1, O2, O4, O6, O8, O15, O16, O18, O25, and O75 was 52.0% (95% CI: 31.3-72.2). E. coli isolates showed highest resistance rates to levofloxacin and ciprofloxacin (76%; 95% CI: 54.8-90.6 for both). Among fluoroquinolone-resistant ExPEC isolates, prevalence of the 10 selected O-serotypes was 60%.
Conclusions:
This study provides an estimate of microbiologically confirmed IED incidence following TRUS-PNB. Information on E. coli O-serotype distribution and associated antibiotic resistance profiles from IED cases in the first 30 days following TRUS-PNB may help guiding antibiotic use and inform development of a prophylactic ExPEC vaccine.
... Currently, some studies indicate that age, BMI ≥ 25 kg/ m 2 , diabetes mellitus, preoperative catheter, prostate volume, multiple punctures, history of hypertension, history of antiplatelet drugs, preoperative antibiotics and clean perfusion are risk factors for infection after TRUS-Bx. 12,[21][22][23][24][25] However, some other scholars suggest that age, prostate volume, history of hypertension, PSA, fPSA/PSA, history of antiplatelet drugs, history of coronary heart disease and pathological results are not risk factors of infection after TURS-PB. 11,23 In this study, we found that age, hypertension, indwelling catheter, prostate volume, PSA, fPSA/PSA, pathological type and antibiotic use history were not independent risk factors of SIRS after TRUS-Bx. ...
... 12,[21][22][23][24][25] However, some other scholars suggest that age, prostate volume, history of hypertension, PSA, fPSA/PSA, history of antiplatelet drugs, history of coronary heart disease and pathological results are not risk factors of infection after TURS-PB. 11,23 In this study, we found that age, hypertension, indwelling catheter, prostate volume, PSA, fPSA/PSA, pathological type and antibiotic use history were not independent risk factors of SIRS after TRUS-Bx. ...
Objective
To explore the risk factors, pathogenic bacteria distribution and drug resistance of systematic transrectal ultrasound-guided prostate biopsy (TRUS-Bx), 329 cases of TRUS-Bx were collected, retrospectively, in the Second Affiliated Hospital, Army Military Medical University, from April 2017 to October 2019.
Methods
A total of 329 cases were all qualified and grouped into the SIRS group (25 cases) and the non-SIRS group (304 cases). Of all the cases, incidence and risk factors of systemic inflammatory response syndrome (SIRS) were analyzed. Urine and blood samples of patients with SIRS after TRUS-Bx were also collected for bacterial culture and drug sensitivity test.
Results
Multivariate logistic regression analysis showed that BMI ≥ 25 kg/m² (OR = 1.66, 95% CI = 1.34–2.12, P <0.001), history of diabetes (OR = 5.48, 95% CI = 1.53–19.68, P = 0.008), urinary infection before operation (OR = 9.19, 95% CI = 2.92–20.93, P < 0.001) and erythrocyte sedimentation (ESR) ≥ 20 mm/h (OR = 1.04, 95% CI = 1.01–1.08, P = 0.039) were independent risk factors of SIRS after TURS-PB.
Conclusion
The incidence of SIRS and urinary sepsis was 7.59% and 2.13%, respectively, and major pathogens of SIRS after TRUS-Bx were Escherichia coli (58.33%), Klebsiella pneumoniae (12.5%) and Pseudomonas aeruginosa (12.5%). Imipenem, meropenem, tigecycline, piperacillin/tazobactam, teicoplanin, vancomycin, amikacin and cefoperazone/sulbactam had a very strong inhibitory effect to those pathogenic bacteria (sensitivity 85.72%~100%). Levofloxacin, ciprofloxacin, gentamicin, penicillin G, compound neonomine and second-generation cephalosporins showed less but also worked as a good inhibitor to pathogenic bacteria (42.86%~80.95%).
... This was followed by K. pneumoniae and other Enterobacteriaceae species (Table 1). Similarly in other studies, resistant E. coli strains were found to be responsible for the highest intestinal colonization rates, which was followed by Klebsiella and other enteric bacteria species [4,20,30,33]. ...
Background:
Antibiotic-resistant Enterobacteriaceae in the gastrointestinal flora can lead to infections with limited therapeutic options. Also, the resistant bacteria can be transferred from colonized persons to others. The present study was conducted to search the fecal carriage rates of (i) Enterobacteriaceae that produce extended-spectrum β-lactamase (ESBL-E) and/or (ii) plasmid-mediated AmpC β-lactamase (pAmpC-E), (iii) ciprofloxacin-resistant Enterobacteriaceae (CIP-RE), and (iv) carbapenem-intermediate or -resistant Enterobacteriaceae (CIRE) in Northern Cyprus.
Methods:
A total of 500 community-dwellers were recruited from consecutive admissions to the clinical laboratories of four hospitals. One rectal swab or stool sample was collected from each participant. A questionnaire was applied to evaluate possible risk factors associated with intestinal colonization of resistant bacteria. The samples were cultured on antibiotic containing media to screen for resistant bacteria colonization. The bacterial colonies that grew on the plates were subjected to further phenotypic tests to confirm the resistance.
Results:
Of 500 volunteers, ESBL-E, pAmpC-E, CIP-RE and CIRE carriage were detected in 107 (21.4%), 15 (3.0%), 51 (10.2%) and six (1.2%) participants, respectively. Escherichia coli was the most commonly recovered species among Enterobacteriaceae isolates. A significant proportion of ESBL-producing E. coli isolates (n = 22/107; 20.6%) was found to be co-resistant to CIP (p = 0.000, OR 3.21, 95% CI 1.76-5.87). In this study, higher socioeconomic status (CIP-RE: p = 0.024, OR 1.96, 95% CI 1.09-3.53), presence of gastrointestinal symptoms (CIRE: p = 0.033; OR 6.79, 95% CI 1.34-34.39), antibiotic use (ESBL-E: p = 0.031; OR 1.67, 95% CI 1.04-2.67; and CIRE: p = 0.033; OR 6.40, 95% CI 1.16-35.39), and travelling abroad (pAmpC-E: p = 0.010; OR 4.12, 95% CI 1.45-11.66) were indentified as risk factors.
Conclusion:
The study indicates that resistant Enterobacteriaceae isolates are carried by humans in the community. To prevent further spread of resistance, rational use of antibiotics should be encouraged, and antibiotic resistance should be carefully monitored in Northern Cyprus.
... Previous studies have found that the incidence of UTI after TRUS-PNB was associated with age, immunosuppression, chronic diseases, and previous use of antibiotics [4,5]. Moreover, the bacterial flora of the rectum and the type of antibiotic prophylaxis used has been correlated with infectious complications after TRUS-PNB [6]. Currently, fluoroquinolones are the most widely used antibiotic prophylaxis for TRUS-PNB [1]. ...
... Currently, fluoroquinolones are the most widely used antibiotic prophylaxis for TRUS-PNB [1]. However, several studies reported an increasing incidence of fluoroquinolone-resistant (FQR) uropathogens [6,7]. These findings urge the reconsideration of fluoroquinolones as the antibiotic of choice for TRUS-PNB prophylaxis. ...
Objectives: To perform a systematic review and meta-analysis of clinical studies to assess the comparative prophylactic effectiveness of fosfomycin trometamol (FMT) vs ciprofloxacin (CIP) in men who underwent transrectal ultrasonography-guided prostate needle biopsy (TRUS-PNB), as infectious complications are a major concern after TRUS-PNB and although fluoroquinolones are currently the first choice, an increase in resistance has raised the question about its recommendation and FMT is a broad-spectrum oral antibiotic with low bacterial resistance.
Methods: A systematic review was performed between January 1970 and June 2017 using the Web of Science, Scopus and PubMed databases to identify relevant studies. Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria were used for article selection. Outcomes of interest were febrile and afebrile urinary tract infections (UTIs) and the presence of fluoroquinolone-resisitant (FQR)- or extended-spectrum β-lactamase (ESBL)-producing uropathogens in urinary cultures.
Results: Four studies including 2331 men were analysed; 1088 had FMT and 1243 CIP as antibiotic prophylaxis before TRUS-PNB. FMT prophylaxis resulted in significantly less afebrile (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.12–0.38; P < 0.001) and febrile (OR 0.15, 95% CI 0.07–0.31; P < 0.001) UTIs than CIP. Amongst all urine cultures, patients in the FMT arm also had a significantly lower prevalence of FQR and ESBL (E. coli or K. pneumoniae) microorganisms when compared to the CIP group (OR 0.25, 95% CI 0.12–0.21, P= 0.001; and OR 0.24, 95% CI 0.10–0.58, P = 0.001, respectively).
Conclusions: Antibiotic prophylaxis with FMT before TRUS-PNB was associated with lower rates of infectious complications when compared to CIP.
Abbreviations: CIP: ciprofloxacin; ESBL: extended-spectrum β-lactamase; FMT: fosfomycin trometamol; FQR: fluoroquinolone-resisitant; OR: odds ratio; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; TRUS-PNB: TRUS-guided prostate needle biopsy
... Several studies have demonstrated that recent hospitalization (<1 month prior to TRUSPB), comorbidities (particularly diabetes), history of urinary infections, history of antibiotic use, and year of biopsy were significantly associated with rates of infectious complications after TRUSPB. 8,14,15 This retrospective study aimed to more precisely explore risk factors of infectious complications following TRUSPB. ...
Objective
To explore risk factors of infectious complications following transrectal ultrasound-guided prostate biopsy (TRUSPB).
Methods
We retrospectively analyzed 1,203 patients with suspected prostate cancer who underwent TRUSPB at our center between December 2012 and December 2016. Demographics, clinical characteristics, and data regarding complications were collected, and then univariate and multivariate logistic regression analyses were used to identify independent risk factors for infectious complications after prostate biopsy.
Results
Multivariate logistic analysis demonstrated that body mass index (BMI) (OR=2.339, 95% CI 2.029–2.697, P<0.001), history of diabetes (OR=2.203, 95% CI 1.090–4.455, P=0.028), and preoperative catheterization (OR=2.303, 95% CI 1.119–4.737, P=0.023) were risk factors for infection after prostate biopsy. The area under the receiver operating characteristics curve for infectious complications was 0.930 (95% CI 0.907–0.953, P<0.001). BMI=28.196 kg/m² was the best cut-off threshold for predicting infection after TRUSPB.
Conclusion
BMI >28.196 kg/m², history of diabetes, and preoperative catheterization are independent risk factors for infection after prostate biopsy.
... We use ciprofloxacin+gentamicin regimen for AP. The most common pathogen was found to be E.Coli as it is similar in our study (24). Despite the antibiotic regimens for prophlaxis infections would be seen due to increased number of multiresistant pathogens (23,24). ...
... The most common pathogen was found to be E.Coli as it is similar in our study (24). Despite the antibiotic regimens for prophlaxis infections would be seen due to increased number of multiresistant pathogens (23,24). Adamczyk et al. (25) recommended first or second generation of cephalosporins for fluoroquinolone-resistant E.Coli species and pointed the importance of rectal swabs for determining the appropriate antibiotic (25). ...
