We retrospectively investigated the incidence of genitourinary tract infection in 5895 patients who underwent transrectal and/or transperineal prostate biopsy procedure between January and December 2011 at 46 institutions belonging to Japanese Research Group for Urinary Tract Infection (JRGU).
The total rate of genitourinary tract infection after prostate biopsy was 0.76%, while that following transrectal procedure was 0.83% and following transperineal procedure was 0.57%, which were not significantly different. In contrast, febrile infection associated with a fever (≥38 °C) occurred significantly more frequently after transrectal (0.71%) than transperineal (0.16%) approach (P = 0.04). Notably, in infectious cases, Escherichia coli was most frequently isolated. Of the 9 E. coli strains isolated by urine culture, 6 (66.7%) produced extended spectrum β-lactamase (ESBL) and 7 (77.8%) showed levofloxacin resistance. Similarly, of 6 E. coli strains isolated by blood culture, 4 (66.7%) produced ESBL and 6 (100%) showed levofloxacin resistance. When the efficacy of antimicrobial prophylaxis (AMP) with levofloxacin for the patients undergoing transrectal or transperineal biopsy was compared between a single dose (500 mg) and that given for 2 or more days, no significant difference was observed for the rate of infection (transrectal: 0.82% vs. 1.04%, p = 0.94; transperineal: 0.30% vs. 0.46%, p = 0.68). Although a single dose of levofloxacin for AMP is sufficient to prevent genitourinary infection after transrectal or transperineal prostate biopsy, and recommended in this era of increased multi-drug resistant pathogens, the increase in fluoroquinolone-resistant E. coli and ESBL-producing E. coli has emerged as a profound problem for surveillance.
Written by:
Togo Y, Kubo T, Taoka R, Hiyama Y, Uehara T, Hashimoto J, Kurimura Y, Takahashi S, Tsukamoto T, Miyazaki J, Nishiyama H, Kira S, Kiyota H, Yazawa S, Niwa N, Hongo H, Oya M, Kato T, Yasuda M, Deguchi T, Ishikawa K, Hoshinaga K, Matsumoto M, Shigemura K, Tanaka K, Arakawa S, Fujisawa M, Wada K, Uehara S, Watanabe T, Kumon H, Kobayashi K, Matsubara A, Matsumoto M, Sho T, Hamasuna R, Matsumoto T, Hayami H, Nakagawa M, Yamamoto S. Are you the author?
Department of Urology, Hyogo College of Medicine, Japan; Department of Public Health, University of Occupational and Environmental Health, Japan; Department of Urology, Sapporo Medical University School of Medicine, Japan; Department of Urology, Faculty of Medicine, University of Tsukuba, Japan; Division of Urology, Jikei University Katsushika Medical Center, Japan; Department of Urology, Keio University School of Medicine, Japan; Department of Urology, Gifu University Graduate School of Medicine, Japan; Department of Urology, Fujita Health University School of Medicine, Japan; Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Japan; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of Urology, Institute of Biomedical & Health Sciences, Hiroshima University, Japan; Department of Urology, University of Occupational and Environmental Health, Japan; Blood Purification Center, Kagoshima University Hospital, Japan; Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan.
Reference: J Infect Chemother. 2013 Dec 11. pii: S1341-321X(13)00042-1.
doi: 10.1016/j.jiac.2013.10.003
PubMed Abstract
PMID: 24594451
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