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Incidence of Acute Prostatitis Caused by Extended-spectrum β-Lactamase-producing Escherichia coli After Transrectal Prostate Biopsy

      Objectives

      To study the clinical and bacteriologic picture of acute prostatitis caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli after transrectal ultrasound-guided prostate biopsy.

      Methods

      The retrospective data from 1339 patients who had undergone transrectal ultrasound-guided biopsy from November 2003 to June 2008 were reviewed. An automatic biopsy gun with an 18-gauge needle was used to obtain 10-core biopsies for first biopsies and ≥12-core for repeat biopsies. These patients had received 500 mg ciprofloxacin orally twice daily for 5 days, beginning 24 hours before biopsy. All biopsies were performed as outpatient procedures.

      Results

      Of the 1339 patients, 28 (2.1%) had acute bacterial prostatitis detected after transrectal ultrasound-guided prostate biopsy. Acute prostatitis occurred after the first biopsy in 15 patients (1.3%) and after repeat biopsy in 13 (6.8%). The patients had developed infective symptoms a mean of 3 days after transrectal ultrasound-guided prostate biopsy. Of the 28 patients, 17 (61%) had positive urine and/or blood cultures, including E. coli in 14. Of the 14 patients, 6 had acute prostatitis caused by ESBL-producing E. coli. Bacteria isolated from urine were tested for drug susceptibility to a wide range of antibiotics. All patients with ESBL-producing E. coli were treated with imipenem. The bacteria detected in these urine cultures were resistant to ciprofloxacin, ceftriaxone, sulbactam/ampicillin, and cefazolin. Imipenem and piperacillin-tazobactam were the most active agents against ESBL-producing E. coli. ESBL-producing isolates had a significant reduction in activity for most antimicrobial agents, including fluoroquinolones and amikacin.

      Conclusions

      The prompt initiation of effective antimicrobial treatment is essential in patients with ESBL-producing E. coli, and empirical decisions must be determined by knowledge of the local distribution of pathogens and their susceptibility.
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      Linked Article

      • Editorial Comment
        UrologyVol. 74Issue 1
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          This is an excellent clinical review of a large number of patients who underwent transrectal ultrasound-guided prostate biopsy (TRUS-BP) during an almost 5-year period. All patients received ciprofloxacin, 500 mg twice daily for 5 days, starting 24 hours before the procedure. All patients underwent a minimum of a 12-core biopsy. The authors reviewed the infectious complications and noted that these occurred in 28 of 1339 patients (2.1%). A slightly greater (and statistically significant) incidence was found in patients undergoing repeat biopsy (6.8%) vs an initial biopsy (1.3%).
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