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Presence of resistant rectal bacteria ups risk of infection after prostate needle biopsy

24 Dec 2017

Patients with fluoroquinolone-resistant rectal vault flora appear to have higher odds of developing infectious complications following transrectal ultrasound-guided prostate needle biopsy despite targeted prophylaxis, a study has found.

Researchers retrospectively reviewed the medical records of 5,214 consecutive patients who underwent transrectal ultrasound-guided prostate needle biopsy. Swab samples were collected and analysed for the presence of fluoroquinolone resistant gram-negative rods. Prophylaxis for biopsy was guided by rectal swab culture.

The Kruskal-Wallis and chi-square tests were applied to compare the characteristics of patients with and without infectious complications. Multivariable logistic regression facilitated identification of factors predicting infectious complications.

Of the 5,214 biopsies performed, a total of 56 infectious (1.1 percent) and 24 sepsis complications (0.46 percent) were identified. On univariable analysis, non-Caucasian race and fluoroquinolone-resistant microbes emerged as predictors of infection (p<0.05).

Following adjustments for potential confounders, infection showed an independent association with fluoroquinolone-resistant rectal vault flora (odds ratio [OR], 9.98; 95 percent CI, 3.79–26.3) and the number of biopsy cores taken (OR, 1.28 per core; 1.04–1.54).

Based on the findings, researchers underscored the need to consider using other biopsy approaches or techniques in patients with fluoroquinolone-resistant rectal vault flora to minimize the risk of infectious complications after transrectal ultrasound-guided prostate needle biopsy.

The presence of resistant intestinal bacteria has been assumed to increase infection risk with resistant bacteria. As such, the state of resistance of strains isolated from rectal swab cultures against prophylactic agents other than fluoroquinolones could aid in the determination of the most accurate regimen to be applied for biopsy procedures. [Turk J Urol 2017;43:210–215]

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Roshini Claire Anthony, 12 Nov 2018

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