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 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 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.

scholarly journals A tale of four valves: outcome of Brucella endocarditis: a case series

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Suraj Kumar Kulkarni ◽  
Shivakumar Bhairappa ◽  
Kapil Rangan ◽  
Beeresh P
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Case Series ◽  
Heart Association ◽  
Limb Ischaemia ◽  
Intermittent Fever ◽  
Peripheral Embolization ◽  
Acute Limb Ischaemia

Abstract Background Brucellosis is a zoonotic infection. Humans contract brucellosis through inhalation of aerosolized infected particles, or when they come in direct contact with infected animal parts, or on consuming unpasteurised dairy products. It can affect multiple organs and systems. Endocarditis is diagnosed late in the course of the disease with mostly aortic valve involvement with serious morbidity and mortality. Case summary We report a case series of four patients with Brucella endocarditis. The first patient presented with fever, malaise, and exertional breathlessness. He underwent aortic valve replacement for refractory heart failure and bulky vegetations after failed medical therapy. The second patient presented with fever, breathlessness New York Heart Association (NYHA) III, with arthralgia, myalgia, anorexia, and weight loss. In view of aortic abscess with impending rupture and compression of left main coronary artery, aortic valve replacement was performed on the 4th day of antibiotic treatment. The third patient presented with fever, fatigue, NYHA II, and developed peripheral embolization but responded to medical treatment alone. The fourth patient presented with intermittent fever for 7 months. During hospitalization, he suffered acute limb ischaemia and stroke with absence of left dorsalis pedis and posterior tibial pulsation. Brucella IgG ELISA was positive. Mitral valve replacement was done subsequently with unremarkable hospital course. Discussion Brucellosis is a challenging diagnosis to make. The diagnosis and treatment is often delayed as it presents with non-specific symptoms and signs. Cardiac involvement occurs in only 2% of the cases, but accounts for 80% of the mortality due to brucellosis. Brucella endocarditis should be suspected in cases of endocarditis with negative blood cultures and a risk of exposure. The most accepted treatment for Brucella endocarditis is a combination of antimicrobial therapy with surgery.

scholarly journals Cutting to the Core of the Issue: Emerging Strategies To Reduce Prostate Biopsy-Related Infections

2016 ◽  
Vol 54 (10) ◽  
pp. 2431-2435 ◽  
Author(s):  
Robin R. Chamberland
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Prostate Biopsy ◽  
Current Trend ◽  
The United States ◽  
Infectious Complications ◽  
Published Data ◽  
The Core ◽  
Link Type ◽  
Transrectal Prostate Biopsy

Over 1 million men undergo biopsy in the United States each year to evaluate for prostate cancer (S. Loeb, H. B. Carter, S. I. Berndt, W. Ricker, and E. M. Schaeffer, J Urol 186:1830–1834, 2011,http://dx.doi.org/10.1016/j.juro.2011.06.057). In recent years, there has been a rise in infectious complications related to these procedures. This review aims to provide an overview of the guidelines that direct transrectal prostate biopsy, to describe associated infection, and to evaluate the published data driving the current trend toward prebiopsy screening for resistant organisms.

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.

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