Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy

Michael A. Liss; Stephen A. Taylor; Deepak Batura; Deborah Steensels; Methee Chayakulkeeree; Charlotte Soenens; G. Gopal Rao; Atreya Dash; Samuel Park; Nishant Patel; Jason Woo; Michelle McDonald; Unwanaobong Nseyo; Pooya Banapour; Stephen Unterberg; Thomas E. Ahlering; Hendrik Van Poppel; Kyoko Sakamoto; Joshua Fierer; Peter C. Black

doi:10.1016/j.juro.2014.06.005

Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy

Michael A. Liss, Stephen A. Taylor, Deepak Batura, Deborah Steensels, Methee Chayakulkeeree, Charlotte Soenens, G. Gopal Rao, Atreya Dash, Samuel Park, Nishant Patel, Jason Woo, Michelle McDonald, Unwanaobong Nseyo, Pooya Banapour, Stephen Unterberg, Thomas E. Ahlering, Hendrik Van Poppel, Kyoko Sakamoto, Joshua Fierer, Peter C. Black

Research output: Contribution to journal › Article › peer-review

59 Scopus citations

Abstract

Purpose Infection after transrectal prostate biopsy has become an increasing concern due to fluoroquinolone resistant bacteria. We determined whether colonization identified by rectal culture can identify men at high risk for post-transrectal prostate biopsy infection.

Materials and Methods Six institutions provided retrospective data through a standardized, web based data entry form on patients undergoing transrectal prostate biopsy who had rectal culture performed. The primary outcome was any post-transrectal prostate biopsy infection and the secondary outcome was hospital admission 30 days after transrectal prostate biopsy. We used chi-square and logistic regression statistical analysis.

Results A total of 2,673 men underwent rectal culture before transrectal prostate biopsy from January 1, 2007 to September 12, 2013. The prevalence of fluoroquinolone resistance was 20.5% (549 of 2,673). Fluoroquinolone resistant positive rectal cultures were associated with post-biopsy infection (6.6% vs 1.6%, p <0.001) and hospitalization (4.4% vs 0.9%, p <0.001). Fluoroquinolone resistant positive rectal culture increased the risk of infection (OR 3.98, 95% CI 2.37-6.71, p <0.001) and subsequent hospital admission (OR 4.77, 95% CI 2.50-9.10, p <0.001). If men only received fluoroquinolone prophylaxis, the infection and hospitalization proportion increased to 8.2% (28 of 343) and 6.1% (21 of 343), with OR 4.77 (95% CI 2.50-9.10, p <0.001) and 5.67 (95% CI 3.00-10.90, p <0.001), respectively. The most common fluoroquinolone resistant bacteria isolates were Escherichia coli (83.7%). Limitations include the retrospective study design, nonstandardized culture and interpretation of resistance methods.

Conclusions Colonization of fluoroquinolone resistant organisms in the rectum identifies men at high risk for infection and subsequent hospitalization from prostate biopsy, especially in those with fluoroquinolone prophylaxis only.

Original language	English (US)
Pages (from-to)	1673-1678
Number of pages	6
Journal	Journal of Urology
Volume	192
Issue number	6
DOIs	https://doi.org/10.1016/j.juro.2014.06.005
State	Published - Dec 1 2014
Externally published	Yes

Keywords

biopsy
drug resistance
infection
microbial
prostate

ASJC Scopus subject areas

Urology

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10.1016/j.juro.2014.06.005

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Liss, M. A., Taylor, S. A., Batura, D., Steensels, D., Chayakulkeeree, M., Soenens, C., Rao, G. G., Dash, A., Park, S., Patel, N., Woo, J., McDonald, M., Nseyo, U., Banapour, P., Unterberg, S., Ahlering, T. E., Van Poppel, H., Sakamoto, K., Fierer, J., & Black, P. C. (2014). Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy. Journal of Urology, 192(6), 1673-1678. https://doi.org/10.1016/j.juro.2014.06.005

Liss, MA, Taylor, SA, Batura, D, Steensels, D, Chayakulkeeree, M, Soenens, C, Rao, GG, Dash, A, Park, S, Patel, N, Woo, J, McDonald, M, Nseyo, U, Banapour, P, Unterberg, S, Ahlering, TE, Van Poppel, H, Sakamoto, K, Fierer, J & Black, PC 2014, 'Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy', Journal of Urology, vol. 192, no. 6, pp. 1673-1678. https://doi.org/10.1016/j.juro.2014.06.005

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title = "Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy",

abstract = "Purpose Infection after transrectal prostate biopsy has become an increasing concern due to fluoroquinolone resistant bacteria. We determined whether colonization identified by rectal culture can identify men at high risk for post-transrectal prostate biopsy infection.Materials and Methods Six institutions provided retrospective data through a standardized, web based data entry form on patients undergoing transrectal prostate biopsy who had rectal culture performed. The primary outcome was any post-transrectal prostate biopsy infection and the secondary outcome was hospital admission 30 days after transrectal prostate biopsy. We used chi-square and logistic regression statistical analysis.Results A total of 2,673 men underwent rectal culture before transrectal prostate biopsy from January 1, 2007 to September 12, 2013. The prevalence of fluoroquinolone resistance was 20.5% (549 of 2,673). Fluoroquinolone resistant positive rectal cultures were associated with post-biopsy infection (6.6% vs 1.6%, p <0.001) and hospitalization (4.4% vs 0.9%, p <0.001). Fluoroquinolone resistant positive rectal culture increased the risk of infection (OR 3.98, 95% CI 2.37-6.71, p <0.001) and subsequent hospital admission (OR 4.77, 95% CI 2.50-9.10, p <0.001). If men only received fluoroquinolone prophylaxis, the infection and hospitalization proportion increased to 8.2% (28 of 343) and 6.1% (21 of 343), with OR 4.77 (95% CI 2.50-9.10, p <0.001) and 5.67 (95% CI 3.00-10.90, p <0.001), respectively. The most common fluoroquinolone resistant bacteria isolates were Escherichia coli (83.7%). Limitations include the retrospective study design, nonstandardized culture and interpretation of resistance methods.Conclusions Colonization of fluoroquinolone resistant organisms in the rectum identifies men at high risk for infection and subsequent hospitalization from prostate biopsy, especially in those with fluoroquinolone prophylaxis only.",

keywords = "biopsy, drug resistance, infection, microbial, prostate",

author = "Liss, {Michael A.} and Taylor, {Stephen A.} and Deepak Batura and Deborah Steensels and Methee Chayakulkeeree and Charlotte Soenens and Rao, {G. Gopal} and Atreya Dash and Samuel Park and Nishant Patel and Jason Woo and Michelle McDonald and Unwanaobong Nseyo and Pooya Banapour and Stephen Unterberg and Ahlering, {Thomas E.} and {Van Poppel}, Hendrik and Kyoko Sakamoto and Joshua Fierer and Black, {Peter C.}",

note = "Publisher Copyright: {\textcopyright} 2014 American Urological Association Education and Research, Inc.",

year = "2014",

month = dec,

day = "1",

doi = "10.1016/j.juro.2014.06.005",

language = "English (US)",

volume = "192",

pages = "1673--1678",

journal = "Journal of Urology",

issn = "0022-5347",

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TY - JOUR

T1 - Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy

AU - Liss, Michael A.

AU - Taylor, Stephen A.

AU - Batura, Deepak

AU - Steensels, Deborah

AU - Chayakulkeeree, Methee

AU - Soenens, Charlotte

AU - Rao, G. Gopal

AU - Dash, Atreya

AU - Park, Samuel

AU - Patel, Nishant

AU - Woo, Jason

AU - McDonald, Michelle

AU - Nseyo, Unwanaobong

AU - Banapour, Pooya

AU - Unterberg, Stephen

AU - Ahlering, Thomas E.

AU - Van Poppel, Hendrik

AU - Sakamoto, Kyoko

AU - Fierer, Joshua

AU - Black, Peter C.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Purpose Infection after transrectal prostate biopsy has become an increasing concern due to fluoroquinolone resistant bacteria. We determined whether colonization identified by rectal culture can identify men at high risk for post-transrectal prostate biopsy infection.Materials and Methods Six institutions provided retrospective data through a standardized, web based data entry form on patients undergoing transrectal prostate biopsy who had rectal culture performed. The primary outcome was any post-transrectal prostate biopsy infection and the secondary outcome was hospital admission 30 days after transrectal prostate biopsy. We used chi-square and logistic regression statistical analysis.Results A total of 2,673 men underwent rectal culture before transrectal prostate biopsy from January 1, 2007 to September 12, 2013. The prevalence of fluoroquinolone resistance was 20.5% (549 of 2,673). Fluoroquinolone resistant positive rectal cultures were associated with post-biopsy infection (6.6% vs 1.6%, p <0.001) and hospitalization (4.4% vs 0.9%, p <0.001). Fluoroquinolone resistant positive rectal culture increased the risk of infection (OR 3.98, 95% CI 2.37-6.71, p <0.001) and subsequent hospital admission (OR 4.77, 95% CI 2.50-9.10, p <0.001). If men only received fluoroquinolone prophylaxis, the infection and hospitalization proportion increased to 8.2% (28 of 343) and 6.1% (21 of 343), with OR 4.77 (95% CI 2.50-9.10, p <0.001) and 5.67 (95% CI 3.00-10.90, p <0.001), respectively. The most common fluoroquinolone resistant bacteria isolates were Escherichia coli (83.7%). Limitations include the retrospective study design, nonstandardized culture and interpretation of resistance methods.Conclusions Colonization of fluoroquinolone resistant organisms in the rectum identifies men at high risk for infection and subsequent hospitalization from prostate biopsy, especially in those with fluoroquinolone prophylaxis only.

AB - Purpose Infection after transrectal prostate biopsy has become an increasing concern due to fluoroquinolone resistant bacteria. We determined whether colonization identified by rectal culture can identify men at high risk for post-transrectal prostate biopsy infection.Materials and Methods Six institutions provided retrospective data through a standardized, web based data entry form on patients undergoing transrectal prostate biopsy who had rectal culture performed. The primary outcome was any post-transrectal prostate biopsy infection and the secondary outcome was hospital admission 30 days after transrectal prostate biopsy. We used chi-square and logistic regression statistical analysis.Results A total of 2,673 men underwent rectal culture before transrectal prostate biopsy from January 1, 2007 to September 12, 2013. The prevalence of fluoroquinolone resistance was 20.5% (549 of 2,673). Fluoroquinolone resistant positive rectal cultures were associated with post-biopsy infection (6.6% vs 1.6%, p <0.001) and hospitalization (4.4% vs 0.9%, p <0.001). Fluoroquinolone resistant positive rectal culture increased the risk of infection (OR 3.98, 95% CI 2.37-6.71, p <0.001) and subsequent hospital admission (OR 4.77, 95% CI 2.50-9.10, p <0.001). If men only received fluoroquinolone prophylaxis, the infection and hospitalization proportion increased to 8.2% (28 of 343) and 6.1% (21 of 343), with OR 4.77 (95% CI 2.50-9.10, p <0.001) and 5.67 (95% CI 3.00-10.90, p <0.001), respectively. The most common fluoroquinolone resistant bacteria isolates were Escherichia coli (83.7%). Limitations include the retrospective study design, nonstandardized culture and interpretation of resistance methods.Conclusions Colonization of fluoroquinolone resistant organisms in the rectum identifies men at high risk for infection and subsequent hospitalization from prostate biopsy, especially in those with fluoroquinolone prophylaxis only.

KW - biopsy

KW - drug resistance

KW - infection

KW - microbial

KW - prostate

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Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy

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