scholarly journals The molecular mechanisms of fluoroquinolone resistance found in rectal swab isolates of Enterobacterales from men undergoing a transrectal prostate biopsy: the rationale for targeted prophylaxis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Katarzyna Piekarska ◽  
Katarzyna Zacharczuk ◽  
Tomasz Wołkowicz ◽  
Mateusz Mokrzyś ◽  
Natalia Wolaniuk ◽  
...  
Keyword(s):  
Prostate Biopsy ◽  
Molecular Mechanisms ◽  
Transrectal Ultrasound ◽  
Infectious Complications ◽  
Quinolone Resistance ◽  
Fluoroquinolone Resistance ◽  
Oral Antibiotic ◽  
E Coli ◽  
Transrectal Prostate Biopsy ◽  
The Common

Abstract Background Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) is considered an essential urological procedure for the histological diagnosis of prostate cancer. It is, however, considered a “contaminated” procedure which may lead to infectious complications. Recent studies suggest a significant share of fluoroquinolone-resistant rectal flora in post-biopsy infections. Methods The molecular mechanisms of fluoroquinolone resistance, including PMQR (plasmid-mediated quinolone resistance) as well as mutation in the QRDRs (quinolone-resistance determining regions) of gyrA, gyrB, parC and parE, among Enterobacterales isolated from 32 of 48 men undergoing a prostate biopsy between November 2015 and April 2016 were investigated. Before the TRUS-Bx procedure, all the patients received an oral antibiotic containing fluoroquinolones. Results In total, 41 Enterobacterales isolates were obtained from rectal swabs. The MIC of ciprofloxacin and the presence of common PMQR determinants were investigated in all the isolates. Nine (21.9%) isolates carried PMQR with qnrS as the only PMQR agent detected. DNA sequencing of the QRDRs in 18 Enterobacterales (E. coli n = 17 and E. cloacae n = 1) isolates with ciprofloxacin MIC ≥ 0.25 mg/l were performed. Substitutions in the following codons were found: GyrA—83 [Ser → Leu, Phe] and 87 [Asp → Asn]; GyrB codon—605 [Met → Leu], ParC codons—80 [Ser → Ile, Arg] and 84 [Glu → Gly, Met, Val, Lys], ParE codons—458 [Ser → Ala], 461 [Glu → Ala] and 512 [Ala → Thr]. Six isolates with ciprofloxacin MIC ≥ 2 mg/l had at least one mutation in GyrA together with qnrS. Conclusions This study provides information on the common presence of PMQRs among Enterobacterales isolates with ciprofloxacin MIC ≥ 0.25 mg/l, obtained from men undergoing TRUS-Bx. This fact may partially explain why some men develop post-TRUS-Bx infections despite ciprofloxacin prophylaxis.

scholarly journals Quinolone Prophylaxis in Transrectal Ultrasound Guided Prostate Biopsy: An Eight-Year Single Center Experience

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Bing-Juin Chiang ◽  
Yeong Shiau Pu ◽  
Shiu-Dong Chung ◽  
Shih-Ping Liu ◽  
Hong-Jeng Yu ◽  
...  
Keyword(s):  
Prostate Biopsy ◽  
Transrectal Ultrasound ◽  
Infectious Complications ◽  
Pipemidic Acid ◽  
Ultrasound Guided ◽  
E Coli ◽  
Single Center Experience ◽  
Significant Difference ◽  
Group A ◽  
Group B

We retrospectively evaluated the efficacy of prophylaxis with pipemidic acid and levofloxacin in transrectal ultrasound guided prostate biopsy (TRUSP-Bx). From January 2002 to December 2004, patients receiving oral pipemidic acid 500 mg twice daily for three days with or without a preoperative intravenous cefazolin 1 gm injection comprised group A. Between January 2005 and December 2009, patients receiving oral levofloxacin 500 mg one hour before biopsy comprised group B. We calculated the annual febrile urinary tract infection (fUTI) rates. Patients’ characteristics, including age, prophylactic antibiotics, biopsy core numbers, pathologic results, PSA, and the spectrums and susceptibility of pathogens, were also evaluated. A total of 1313 (35.5%) patients belonged to group A, while 2381 (64.5%) patients belonged to group B. Seventy-three patients experienced postoperative infectious complications. There was a significant difference in the fUTI rate between groups A and B (3.7% versus 1.0%,P<0.001). The yearly fUTI rates varied from 0.6 to 3.9% between 2002 and 2009. Of the 73 patients with fUTI, those receiving levofloxacin prophylaxis were more likely to harbor fluoroquinolone-resistant pathogens (P<0.001).E. coliwas the most common pathogen in both groups. Levofloxacin remains effective and appears superior to pipemidic acid based prophylaxis.

scholarly journals Acute Aortic Valve Rupture from Infective Endocarditis after Transrectal Prostate Biopsy: A Call to Revise the AHA Guidelines for Prevention of Infective Endocarditis

2013 ◽  
Vol 6 ◽  
pp. CCRep.S10503 ◽  
Author(s):  
Julia Ansari ◽  
Gurkaran Singh Garcha ◽  
Henry Huang ◽  
Faisal G. Bakaeen ◽  
Salim S. Virani ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Prostate Biopsy ◽  
Transrectal Ultrasound ◽  
Febrile Illness ◽  
Heart Association ◽  
Infectious Complications ◽  
Medical Work ◽  
Intermittent Fever ◽  
Transrectal Prostate Biopsy

We describe the case of a 63-year-old man with a known murmur who presented with a 4-month history of intermittent fever and a progressive reduction in energy level after a transrectal prostate biopsy (TRPB). He subsequently presented with acute heart failure secondary to aortic valve cusp rupture caused by endocarditis and underwent urgent aortic valve surgery. The 2008 American College of Cardiology/American Heart Association Guideline update on infective endocarditis has narrowed the use of antibiotic prophylaxis before most accepted dental procedures and continues to recommend against prophylaxis before genitourinary or gastrointestinal procedures. In contrast, the American Urological Association recommends the use of fluoroquinolones for the prevention of transrectal ultrasound–derived infectious complications. Notably, TRPB is associated with a high frequency of bacteremia and bacteriuria. In our case, an antibiotic course before the procedure and a more meticulous medical work-up after febrile illness might have mitigated the patient's catastrophic medical presentation.

scholarly journals The management of rectal bleeding following transrectal prostate biopsy: A review of the current literature

2017 ◽  
Vol 12 (3) ◽  
pp. E146-53 ◽  
Author(s):  
Mark R. Quinlan ◽  
Damien M. Bolton ◽  
Rowan G. Casey
Keyword(s):  
Rectal Bleeding ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Endoscopic Sclerotherapy ◽  
Trus Biopsy ◽  
Surgical Methods ◽  
Transrectal Prostate Biopsy ◽  
Life Threatening ◽  
The Common

Introduction: Since the advent of prostate-specific antigen (PSA)-based testing, transrectal ultrasound (TRUS)-guided prostate biopsy has become a standard part of the diagnostic pathway for prostate cancer (PCa). Rectal bleeding is one of the common side effects of this transrectal route. While rectal bleeding is usually mild and self-limiting, it can be life-threatening. In this article, we examine rectal bleeding post TRUS-guided prostate biopsy and explore the literature to evaluate techniques and strategies aimed at preventing and managing this common and important complication.Methods: A PubMed literature search was carried out using the keywords “transrectal-prostate-biopsy-bleed.” A search of the bibliography of reviewed studies was also conducted. Additionally, papers in non-PubMed-listed journals of which the authors were aware were appraised.Results: Numerous modifiable risk factors for this bleeding complication exist, particularly anticoagulants/antiplatelets and the number of core biopsies taken. Successfully described corrective measures for such rectal bleeding include tamponade (digital/packs/catheter/tampon/condom), endoscopic sclerotherapy/banding/clipping, radiological embolization, and surgical intervention.Conclusions: We advocate early consultation with the colorectal/gastroenterology and interventional radiology services and a progressive, stepwise approach to the management of post-biopsy rectal bleeding, starting with resuscitation and conservative tamponade measures, moving to endoscopic hemostasis ± radiological embolization ± transanal surgical methods. Given the infrequent but serious nature of major rectal bleeding after TRUS biopsy, we recommend the establishment of centralized databases or registries forthwith to prospectively capture such data. To the best of our knowledge, this is the first comprehensive look specifically at the management of post-TRUS biopsy rectal bleeding.

scholarly journals Combined antibiotic prophylaxis of infectious complications of prostate biopsy

2021 ◽  
Vol 22 (3) ◽  
pp. 49-55
Author(s):  
N. A. Grigoryev ◽  
I. I. Abdullin ◽  
B. R. Gvasalia ◽  
A. V. Loginov ◽  
E. V. Zhilyaev
Keyword(s):  
Antibiotic Prophylaxis ◽  
Prostate Biopsy ◽  
Antimicrobial Prophylaxis ◽  
Average Length ◽  
Infectious Complications ◽  
Fluoroquinolone Resistance ◽  
Single Shot ◽  
Average Length Of Stay ◽  
Transrectal Prostate Biopsy ◽  
Fosfomycin Trometamol

Introduction. Biopsy of prostate is a routine urologic procedure. Nevertheless the frequency of infectious-inflammatory complications remain high, despite the recommended antibiotic prophylaxis schemes.Purpose. The evaluation of effectiveness and safety of combined antimicrobial prophylaxis: fosfomycin trometamol and fluoroquinolones of 3rd generation.Materials and methods. Our clinical study included 80 patients who underwent prostate biopsy were divided into 2 groups. The first group of 40 patients received routine prophylaxis: levofloxacin 500 mg 6 h before the biopsy and 500 mg per day during 4 days after biopsy. The second group of 40 patients, along with standard prophylaxis as in the first group, additionally after biopsy received fosfomycin trometamol 3 gr single-shot.Results. In the first group, infectious and inflammatory complications occurred in 8 (20 %) patients, 12.5 % of patients from the first group were hospitalized for parenteral antibiotic therapy. The average length of stay in hospital was 3.4 ± 1.45 days. In all cases, in the first group of patients, Escherichia coli was detected, in 70 % of cases fluoroquinolone-resistant strain of the bacterium was received. In the second group of patients no hospitalization was required. One (2.5 %) patient out of forty from this group showed signs of urinary tract infection, which was not accompanied by an increase of body temperature, as well as changes in blood and urine tests.Conclusions. Our results show good effectiveness and safety of combined antibiotic prophylaxis for transrectal prostate biopsy. Since fluoroquinolone resistance grows, it is necessary to introduce alternative schemes, as well as monitoring of nosocomial infection and controlling of antimicrobial therapy.

scholarly journals Prevalence, Risk Factors, and Clinical Relevance of Fluoroquinolone-Resistant Organisms in Rectal Cultures: Should We Target Antibiotic Prophylaxis Prior to Prostate Biopsy?

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
J. Van Besien ◽  
P. Uvin ◽  
A. M. Van den Abeele ◽  
L. Merckx
Keyword(s):  
Antibiotic Prophylaxis ◽  
Prostate Biopsy ◽  
Infectious Complications ◽  
Fluoroquinolone Resistance ◽  
Resistant Bacteria ◽  
Confounding Variables ◽  
Transrectal Prostate Biopsy ◽  
Patients At Risk ◽  
Resistance Rates ◽  
Targeted Approach

The rise of infectious complications after prostate biopsy has been linked to the growing resistance of enterobacteria to fluoroquinolone (FQ) antibiotics. In this review, we investigated the potential benefit of targeted antibiotic prophylaxis based on rectal cultures prior to prostate biopsy. An electronic search for all related literature published in English was performed from April until June 2015 using the MEDLINE and EMBASE databases. Data were obtained regarding the true prevalence of FQ-resistant bacteria in the rectum of patients, the identification of those patients at risk of harbouring FQ-resistant bacteria, the risk of infectious complications after transrectal prostate biopsy in patients with FQ-resistant bacteria, and the effect of targeted prophylaxis. Although there is limited evidence that a targeted approach might be beneficial, we conclude that current studies on the use of rectal cultures in the prebiopsy setting have too many limitations and confounding variables to definitely accept this approach in clinical practice. Whether this methodology is useful in a certain region will greatly depend on local fluoroquinolone-resistance rates.

scholarly journals Contributions of individual mechanisms to fluoroquinolone resistance in 36 Escherichia coli strains isolated from humans and animals.

1996 ◽  
Vol 40 (10) ◽  
pp. 2380-2386 ◽  
Author(s):  
M J Everett ◽  
Y F Jin ◽  
V Ricci ◽  
L J Piddock
Keyword(s):  
Escherichia Coli ◽  
Dna Sequences ◽  
Quinolone Resistance ◽  
Fluoroquinolone Resistance ◽  
Polymorphism Analysis ◽  
Single Mutation ◽  
Wild Type ◽  
Single Strand Conformational Polymorphism ◽  
E Coli ◽  
High Level

Twenty-eight human isolates of Escherichia coli from Argentina and Spain and eight veterinary isolates received from the Ministry of Agriculture Fisheries and Foods in the United Kingdom required 2 to > 128 micrograms of ciprofloxacin per ml for inhibition. Fragments of gyrA and parC encompassing the quinolone resistance-determining region were amplified by PCR, and the DNA sequences of the fragments were determined. All isolates contained a mutation in gyrA of a serine at position 83 (Ser83) to an Leu, and 26 isolates also contained a mutation of Asp87 to one of four amino acids: Asn (n = 14), Tyr (n = 6), Gly (n = 5), or His (n = 1). Twenty-four isolates contained a single mutation in parC, either a Ser80 to Ile (n = 17) or Arg (n = 2) or a Glu84 to Lys (n = 3). The role of a mutation in gyrB was investigated by introducing wild-type gyrB (pBP548) into all isolates; for three transformants MICs of ciprofloxacin were reduced; however, sequencing of PCR-derived fragments containing the gyrB quinolone resistance-determining region revealed no changes. The analogous region of parE was analyzed in 34 of 36 isolates by single-strand conformational polymorphism analysis and sequencing; however, no amino acid substitutions were discovered. The outer membrane protein and lipopolysaccharide profiles of all isolates were compared with those of reference strains, and the concentration of ciprofloxacin accumulated (with or without 100 microM carbony cyanide m-chlorophenylhydrazone [CCCP] was determined. Twenty-two isolates accumulated significantly lower concentrations of ciprofloxacin than the wild-type E. coli isolate; nine isolates accumulated less then half the concentration. The addition of CCCP increased the concentration of ciprofloxacin accumulated, and in all but one isolate the percent increase was greater than that in the control strains. The data indicate that high-level fluoroquinolone resistance in E. coli involves the acquisition of mutations at multiple loci.

Rectal E. coli above ciprofloxacin ECOFF associate with infectious complications following prostate biopsy

2018 ◽  
Vol 37 (6) ◽  
pp. 1055-1060 ◽  
Author(s):  
Inari Kalalahti ◽  
Kaisa Huotari ◽  
Kanerva Lahdensuo ◽  
Eveliina Tarkka ◽  
Henrikki Santti ◽  
...  
Keyword(s):  
Prostate Biopsy ◽  
Infectious Complications ◽  
E Coli

scholarly journals Impact of Rectal Swabs on Infectious Complications after Transrectal Prostate Biopsy

2016 ◽  
Vol 97 (3) ◽  
pp. 340-346 ◽  
Author(s):  
Carlos Gustavo Trujillo ◽  
Mauricio Plata ◽  
Juan Ignacio Caicedo ◽  
Juan Guillermo Cataño Cataño ◽  
Angela Marcela Mariño Alvarez ◽  
...  
Keyword(s):  
Prostate Biopsy ◽  
Infectious Complications ◽  
Rectal Swabs ◽  
Transrectal Prostate Biopsy

scholarly journals Complications of Prostate Biopsy: A Prospective, Single-institution Study

2020 ◽  
pp. 271-279
Author(s):  
Colette M. Antoine ◽  
Belinda F. Morrison ◽  
Michael E. Brooks
Keyword(s):  
Urinary Tract ◽  
Urinary Retention ◽  
Prostate Biopsy ◽  
Public Hospital ◽  
Retention Rate ◽  
Tertiary Care ◽  
Transrectal Ultrasound ◽  
Final Analysis ◽  
Infectious Complications ◽  
Prostate Biopsies

Aims:  This study aimed to determine the prevalence rates of transrectal ultrasound-guided prostate biopsy-related complications among patients receiving treatment at the large tertiary-care urology clinic of Kingston Public Hospital (KPH), Jamaica. Study Design: Prospective cohort study. Place and Duration of Study: Kingston Public Hospital (KPH), Jamaica from July 2018 to April 2019. Methodology: Our study population included men who underwent prostate biopsy at KPH. Data on demographics and clinical characteristics were collected using purpose-designed questionnaires from consenting patients who underwent prostate biopsy during the stated period. Patients were then followed up for complications 30 days post biopsy. Details regarding hospitalization due to biopsy-related complications were obtained from the medical records. Results: Data from 185 men were included in the final analysis. Among the patients biopsied, 49% were diagnosed with prostate cancer, while 72% experienced at least one complication, mainly non-infectious complications such as hematuria (46%), lower urinary tract symptoms (24%), rectal bleeding (23%), hematospermia (9%), and urinary retention (16%). Overall, a 15% risk of developing infectious complications was observed, with 9% experiencing fever and 3% experiencing both urinary tract infection and epididymo-orchitis. Our data showed a 6% hospitalization rate within 30 days, with all available records suggesting infectious complications. One death from a prostatic abscess was noted. The present study showed that most prostate biopsy complications were minor. Moreover, although bleeding and infectious complications as well as hospitalization rates were consistent with those reported in larger series, our population experienced a slightly higher mortality and urinary retention rate. Conclusion: Overall, our results showed that prostate biopsies performed within our institution are generally safe and well tolerated. Nonetheless, further studies are needed to determine whether morbidity of the procedure remains acceptable.

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