Escherichia coli. Infección urinaria.
Department of Urology, Escherichia coli in Prostata. Infectious complications after transrectal Escherichia coli in Prostata- prostate biopsy TRUS-Bx appear to Escherichia coli in Prostata- increasing, which reflects Escherichia coli in Prostata- high prevalence of antibiotic-resistant strains of Enterobacteriaceae.
Identifying patients at high risk for antibiotic resistance with history taking is an important initial step. Targeted prophylaxis with a Escherichia coli in Prostata- rectal swab culture or augmented antibiotic prophylaxis can be considered for patients at high risk of antibiotic resistance.
If infectious complications are suspected, the presence of urosepsis should be evaluated and adequate antibiotic treatment should be started immediately.
Transrectal ultrasound-guided prostate biopsy TRUS-Bx is one of the most commonly performed urologic procedures in the United States and Europe, with approximately one million biopsies performed annually on each continent. TRUS-Bx is a relatively safe procedure and the chances of severe complications are low, but the incidence of infectious complications has recently been rising, along with the potential for more severe complications such as sepsis [ 12 Escherichia coli in Prostata.
Randomized controlled trials have shown that antibiotic prophylaxis is effective in preventing infectious complications following TRUS-Bx [ 7 ]. Fluoroquinolone is the most commonly used antibiotic agent for prophylaxis [ 78 ].
However, worldwide antibiotic resistance is rising [ 91011 ], and as such, infectious complications after TRUS-Bx by fluoroquinolone-resistant E. In another Asia-Europe multicenter study that included Korea, the reported incidence of febrile urinary tract infection UTI was 3. In Japan, the reported incidence of febrile UTI was from 0. In a study that analyzed complications after prostate biopsy from SEER Surveillance, Epidemiology and End Results -Medicare data from toinfectious complications after prostate biopsy increased Escherichia coli in Prostata- recent years [ 1 ].
In a Canadian report, the incidence of infectious complications that required admission was 1. Another recent Canadian report also stated that the incidence of infectious complications Escherichia coli in Prostata- 0. The main reason for this increase in infectious complications is the rise in fluoroquinolone resistance [ 9 ]. In a Japanese study, acute bacterial prostatitis developed in 1. In another Japanese study, the rate of genitourinary tract infection was 0.
In a North American cohort, 2. In a French Escherichia coli in Prostata- study, 0. In an Australian study that analyzed E. Along with the problem of fluoroquinolone resistance, one should also be wary of the emergence of extended-spectrum beta-lactamase ESBL -producing bacteria.
Investigators from the United States [ 12 ] and Japan [ 30 ] monitored the rates of fluoroquinolone-resistant E. The purpose of monitoring for fluoroquinolone-resistant E. Targeted prophylaxis may not only prevent infectious complications Escherichia coli in Prostata- sepsis after TRUS-Bx but also suppress the rise of antibiotic-resistant bacteria.
In a study conducted to evaluate targeted antibiotic prophylaxis in men undergoing TRUS-Bx in the United States, there were no infectious complications in the men who received targeted antibiotic prophylaxis, whereas there were 9 cases including 1 of sepsis among the men on empirical therapy [ 31 ].
However, debate remains as to whether rectal swab cultures should be routinely performed before TRUS-Bx. In a Canadian study, despite a significant correlation between patients who developed infections and the detection of ciprofloxacinresistant organisms, only 9. Future studies will need to evaluate the cost effectiveness and clinical utility of a prebiopsy rectal culture in targeted antibiotic prophylaxis [ 32 ].
Fluoroquinolone use in the previous 3 to 6 months prior to TRUS-Bx Escherichia coli in Prostata- a common risk factor for fluoroquinolone resistance in several studies [ 5333435 ]. The longer the period of fluoroquinolone use, the higher the incidence of fluoroquinolone resistance [ 35 ].
Therefore, thorough history taking is of paramount importance Escherichia coli in Prostata- identifying recent fluoroquinolone usage for other conditions such Escherichia coli in Prostata- UTI, chronic prostatitis, heart valve surgery, and artificial instrument insertion surgery Fig. However, in cases of a high risk of fluoroquinolone resistance, performing prebiopsy rectal swab culture to identify rectal bacterial flora would be of great assistance in preventing or treating infectious complications.
If the patient has a history of recent antibiotic use, however, prebiopsy rectal swab culture should be postponed or its results should be interpreted cautiously.
Targeted antibiotic prophylaxis based on rectal swab culture results showed a notable decrease in the incidence of infectious complications after TRUS-Bx caused by fluoroquinolone-resistant organisms as well as a decrease in the overall cost of care [ 31 ].
However, in regions such as Korea where the rate of fluoroquinolone resistance is high, following the US and European guidelines may be less effective for antibiotic prophylaxis. If prebiopsy rectal swab culture is done, susceptible antibiotic agents should be used, and if it is not done, prophylactic antibiotic agents should be changed in patients suspected of fluoroquinolone resistance. For this, attempts have been made to add an aminoglycoside such as amikacin to fluoroquinolone or to Escherichia coli in Prostata- third-generation cephalosporins for prophylaxis.
However, this may cause another problem in addition to fluoroquinolone resistance: emergence of ESBL-producing bacteria. ESBL-producing bacteria are usually resistant to most antibiotics with the exception of carbapenems imipenem, meropenem. Because infectious complications af ter TRUS-Bx could be fatal, immediate admission and implementation of antibiotics is warranted in cases suspected of sepsis. If a prebiopsy rectal swab culture is done, a susceptible antibiotic agent targeting the suspected causative bacteria should be used.
If not, third-generation cephalosporins and aminoglycoside may be the optimal choice, at least in Korea [ 25 ]. Because resistance to gentamicin and tobramycin is already high in Korea, amikacin is the recommended aminoglycoside. If ESBL-producing bacteria are suspected or cephalosporins are ineffective, use of carbapenems such as imipenem or meropenem should not be delayed.
Once the results of the antibiotic susceptibility test are confirmed, de-escalation therapy is recommended, which consists of switching from a broad-spectrum empiric antibiotic therapy to a narrower spectrum. After the patient is discharged, continued treatment for a sufficient period of time is necessary to cure prostatitis. Infectious complications after TRUS-Bx are increasing, and this appears to be due to an increasing Escherichia coli in Prostata- of floroquinolone-resistant strains in the rectal flora.
Therefore, identifying the risk for fecal carriage of floroquinolone-resistant strains by history taking should be the initial step in the TRUS-Bx procedure. If a risk of fluoroquinolone resistance is present, targeted antimicrobial prophylaxis using rectal swab cultures or alternative antibiotics may be recommended for prophylaxis. In patients with infectious complications after TRUS-Bx, it is essential to administer appropriate antibiotics immediately.
National Center for Biotechnology InformationU. Journal List Korean J Urol v. Korean J Urol. Published online Apr 6. Seung-Ju Lee. Find articles by Seung-Ju Lee. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Corresponding Author: Seung-Ju Lee. Received Jan 2; Accepted Mar This article has been cited by other articles in PMC.
Abstract Infectious complications after transrectal ultrasound-guided prostate biopsy TRUS-Bx appear to be increasing, which reflects the high prevalence of antibiotic-resistant strains of Enterobacteriaceae. Keywords: Biopsy, Infection, Prostate. Identifying high-risk patients with history taking Fluoroquinolone use in the previous 3 to 6 months prior to TRUS-Bx was a common risk factor for fluoroquinolone resistance in several studies [ 5333435 ].
Open in a separate window. Flow chart to choose antibiotic prophylaxis for transrectal prostate biopsy. Targeted antibiotic prophylaxis The evidence for routine rectal swab culture before all TRUS-Bx is still Escherichia coli in Prostata.
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