Despite rectal swab culture directed prophylaxis, men with FQ-resistant rectal flora have an increased risk of an infectious complication from a TRUS-PNB. Hence, we sought to evaluate the patient-related factors associated with FQ resistance rectal swabs in men who are undergoing TRUS-PNB.
In this study, we found that increasing age, recent antimicrobial-use, and non-Caucasian race were independent predictors of FQ-resistance in the rectal vault (Table 1). However, given the odds ratio for age is 1.01 with a narrow 95% confidence interval of 1.00-1.02, this finding is less clinically significant whereas antimicrobials usage within 6 months and racial minorities are clearly associated with FQ-resistant rectal flora. Of all the races, Asian men were found to have the highest odds (3.39) of harboring FQ-resistant organism.
Table 1: Multivariable analysis for patient factors of infection
These patients who are at increased risk of an infection following a TRUS-PNB may benefit from an alternative means of screening for prostate cancer, such as a multi-parametric MRI of the prostate and transperineal biopsy of the prostate when it is warranted. As FQ-resistance is associated with infectious complications from transrectal ultrasound guided prostate needle biopsy, understanding risk factors may assist infection control efforts.
Written by: Wei Phin Tan, MD, Urologic Oncology Fellow at Duke University Medical Center, Raleigh-Durham, North Carolina
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