Korean J Urol.  2014 Mar;55(3):201-206. 10.4111/kju.2014.55.3.201.

Prevalence of Antibiotic-Resistant Bacteria on Rectal Swabs and Factors Affecting Resistance to Antibiotics in Patients Undergoing Prostate Biopsy

• Kim JB
• Jung SI
• Hwang EC
• Kwon DD

• KMID: 1988425
• DOI: http://doi.org/10.4111/kju.2014.55.3.201

Abstract

PURPOSE
The prevalence of antibiotic-resistant bacteria on rectal swabs in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy and the factors affecting resistance to antibiotics were evaluated.
MATERIALS AND METHODS
Two hundred twenty-three men who underwent TRUS-guided prostate biopsy from November 2011 to December 2012 were retrospectively evaluated. Rectal swabs were cultured on MacConkey agar to identify antibiotic-resistant bacteria in rectal flora before TRUS-guided prostate biopsy. All patients were admitted and received intravenous antibiotics before prostate biopsy. Clinical variables including underlying disease, infectious complications, and antibiotics associated with resistance were evaluated. Logistic regression was used to determine the factors influencing antibiotic resistance.
RESULTS
Of the 233 patients, 161 had positive rectal cultures. Escherichia coli was cultured in 130 (80.7%) and Klebsiella pneumonia in 16 (9.9%). The prevalence of quinolone resistance was 16.8% and the prevalence of extended-spectrum beta-lactamase (ESBL) positivity was 9.3%. A previous history of prostatitis was correlated with quinolone resistance and ESBL positivity (both p=0.001). The factors affecting quinolone resistance in the univariate analysis were a previous history of prostatitis (p=0.003) and previous exposure to antibiotics (p=0.040). Only a previous history of prostatitis was statistically significant in the multivariate analysis (p=0.014). Four patients had infectious complications.
CONCLUSIONS
The prevalence of quinolone resistance was 16.8% in rectal swabs performed before TRUS-guided prostate biopsy. A previous history of prostatitis was influential. In patients with a history of prostatitis, selection of prophylactic antibiotics before the biopsy may be reconsidered.

Keyword

Bacteria; Biopsy; Drug resistance; Prostate; Risk factors

MeSH Terms

Agar
Anti-Bacterial Agents*
Bacteria*
beta-Lactamases
Biopsy*
Communicable Diseases
Drug Resistance
Drug Resistance, Microbial
Escherichia coli
Humans
Klebsiella
Logistic Models
Male
Multivariate Analysis
Pneumonia
Prevalence*
Prostate*
Prostatitis
Retrospective Studies
Risk Factors
Ultrasonography
Agar
Anti-Bacterial Agents
beta-Lactamases

Reference

1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010; 127:2893–2917.

2. Raaijmakers R, Kirkels WJ, Roobol MJ, Wildhagen MF, Schrder FH. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology. 2002; 60:826–830.

3. Bootsma AM, Laguna Pes MP, Geerlings SE, Goossens A. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol. 2008; 54:1270–1286.

4. Taylor HM, Bingham JB. Antibiotic prophylaxis for transrectal prostate biopsy. J Antimicrob Chemother. 1997; 39:115–117.

5. Kapoor DA, Klimberg IW, Malek GH, Wegenke JD, Cox CE, Patterson AL, et al. Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy. Urology. 1998; 52:552–558.

6. Hooper DC, Wolfson JS. The fluoroquinolones: pharmacology, clinical uses, and toxicities in humans. Antimicrob Agents Chemother. 1985; 28:716–721.

7. Wolfson JS, Hooper DC. Treatment of genitourinary tract infections with fluoroquinolones: activity in vitro, pharmacokinetics, and clinical efficacy in urinary tract infections and prostatitis. Antimicrob Agents Chemother. 1989; 33:1655–1661.

8. Akduman B, Akduman D, Tokgoz H, Erol B, Turker T, Ayoglu F, et al. Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms. Urology. 2011; 78:250–255.

9. Ozden E, Bostanci Y, Yakupoglu KY, Akdeniz E, Yilmaz AF, Tulek N, et al. Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy. Urology. 2009; 74:119–123.

10. Duplessis CA, Bavaro M, Simons MP, Marguet C, Santomauro M, Auge B, et al. Rectal cultures before transrectal ultrasound-guided prostate biopsy reduce post-prostaticbiopsy infection rates. Urology. 2012; 79:556–561.

11. Zaytoun OM, Vargo EH, Rajan R, Berglund R, Gordon S, Jones JS. Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment. Urology. 2011; 77:1035–1041.

12. Zaytoun OM, Anil T, Moussa AS, Jianbo L, Fareed K, Jones JS. Morbidity of prostate biopsy after simplified versus complex preparation protocols: assessment of risk factors. Urology. 2011; 77:910–914.

13. Minamida S, Satoh T, Tabata K, Kimura M, Tsumura H, Kurosaka S, et al. Prevalence of fluoroquinolone-resistant Escherichia coli before and incidence of acute bacterial prostatitis after prostate biopsy. Urology. 2011; 78:1235–1239.

14. Liss MA, Chang A, Santos R, Nakama-Peeples A, Peterson EM, Osann K, et al. Prevalence and significance of fluoroquinolone resistant Escherichia coli in patients undergoing transrectal ultrasound guided prostate needle biopsy. J Urol. 2011; 185:1283–1288.

15. Shandera KC, Thibault GP, Deshon GE Jr. Variability in patient preparation for prostate biopsy among American urologists. Urology. 1998; 52:644–646.

16. Drusano GL, Preston SL, Van Guilder M, North D, Gombert M, Oefelein M, et al. A population pharmacokinetic analysis of the penetration of the prostate by levofloxacin. Antimicrob Agents Chemother. 2000; 44:2046–2051.

17. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, Mason MD, et al. Guidelines on prostate cancer [Internet]. Arnhem (NL): European Association of Urology;c2013. cited 2013 May 10. Available from: http://www.uroweb.org/gls/pdf/09_Prostate_Cancer_LR.pdf.

18. Tal R, Livne PM, Lask DM, Baniel J. Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy. J Urol. 2003; 169:1762–1765.

19. Abughosh Z, Margolick J, Goldenberg SL, Taylor SA, Afshar K, Bell R, et al. A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy. J Urol. 2013; 189:1326–1331.

20. Aron M, Rajeev TP, Gupta NP. Antibiotic prophylaxis for transrectal needle biopsy of the prostate: a randomized controlled study. BJU Int. 2000; 85:682–685.

21. Horcajada JP, Vila J, Moreno-Martinez A, Ruiz J, Martinez JA, Sanchez M, et al. Molecular epidemiology and evolution of resistance to quinolones in Escherichia coli after prolonged administration of ciprofloxacin in patients with prostatitis. J Antimicrob Chemother. 2002; 49:55–59.

22. Steensels D, Slabbaert K, De Wever L, Vermeersch P, Van Poppel H, Verhaegen J. Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy: should we reassess our practices for antibiotic prophylaxis? Clin Microbiol Infect. 2012; 18:575–581.

23. Shin BS, Hwang EC, Jung SI, Kwon DD, Park KS, Ryu SB, et al. Clinical features of bacteremia caused by ciprofloxacin-resistant bacteria after transrectal ultrasound-guided prostate biopsy. Korean J Urogenit Tract Infect Inflamm. 2011; 6:61–66.

24. Siriboon S, Tiengrim S, Taweemongkongsup T, Thamlikitkul V, Chayakulkeeree M. Prevalence of antibiotic resistance in fecal flora of patients undergoing transrectal ultrasound-guided prostate biopsy in Thailand. Urol Int. 2012; 88:187–193.

25. Kanafani ZA, Mehio-Sibai A, Araj GF, Kanaan M, Kanj SS. Epidemiology and risk factors for extended-spectrum beta-lactamase-producing organisms: a case control study at a tertiary care center in Lebanon. Am J Infect Control. 2005; 33:326–332.

26. Lautenbach E, Patel JB, Bilker WB, Edelstein PH, Fishman NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis. 2001; 32:1162–1171.

27. Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev. 2005; 18:657–686.

28. Taylor AK, Zembower TR, Nadler RB, Scheetz MH, Cashy JP, Bowen D, et al. Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol. 2012; 187:1275–1279.

29. Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. Eur Urol. 2013; 64:876–892.

30. Jung SI. Infection in patients undergoing transrectal ultrasound guided prostate biopsy. Korean J Urogenit Tract Infect Inflamm. 2013; 8:20–26.