Prevalence of Fluoroquinolone-resistant Escherichia Coli Before and Incidence of Acute Bacterial Prostatitis After Prostate Biopsy

Objective: To study the prevalence of fluoroquinolone-resistant Escherichia coli before transrectal ultrasound (TRUS)-guided prostate biopsy and prospectively analyze the rates of infective complications after biopsy in patients receiving fluoroquinolone prophylaxis. E. coli is the pathogen most commonly associated with infections after TRUS-guided prostate biopsy, and the prevalence of fluoroquinolone-resistant E. coli is increasing.

Methods: We analyzed the prospective data from 100 patients who underwent TRUS-guided prostate biopsy from April to December 2010. A stool culture was obtained 1 month before biopsy. Patients received 500 mg levofloxacin orally once daily for 3 days, beginning 2 hours before biopsy. All biopsies were performed as outpatient procedures.

Results: Of the 100 patients, 13 (13%) had a stool culture positive for fluoroquinolone-resistant E. coli. In 4 (31%) of these 13 patients, acute bacterial prostatitis was detected after TRUS-guided prostate biopsy. Of the 87 patients whose stool culture was negative for fluoroquinolone-resistant E. coli, none had acute bacterial prostatitis. All 13 infected patients were treated with carbapenems immediately after diagnosis of prostatitis and made a complete recovery.

Conclusion: Prophylactic fluoroquinolone is still effective in preventing acute bacterial prostatitis after TRUS-guided prostate biopsy. The incidence is relatively low in patients with fluoroquinolone-sensitive E. coli. However, the prevalence of fluoroquinolone-resistant E. coli is about 13% in this population. Stool cultures for the detection of fluoroquinolone-resistant E. coli might be obtained before TRUS-guided prostate biopsy.