Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Transrectal prostate biopsies carry the risk of infection. By using non-selective culture plates, instead of commonly used ciprofloxacin (CIP)-containing plates, we analyzed the association between Escherichia coli CIP minimal inhibitory concentration (MIC) and post-biopsy infectious complications. A pre-biopsy rectal swab was taken from 207 consecutive men, scheduled for transrectal 12-core prostate biopsy with CIP 750 mg as the mostly used prophylaxis. CIP MIC of rectal Gram-negative bacilli was determined from a chromogenic agar. Rectal E. coli were categorized to resistant (R) and intermediate (I) isolates together (R + I, MIC > 0.25 mg/l) and to sensitive (S, MIC ≤ 0.25 mg/l) using EUCAST clinical breakpoints. In addition, epidemiological cutoff (ECOFF R, MIC > 0.064 mg/l) was used for categorization. Eighteen (8.7%) men showed CIP R + I E. coli by the EUCAST breakpoints and 41 (19.8%) using the ECOFF R criteria. During follow-up, 15 (7.2%) men had infectious symptoms, of which 9 (4.3%) were culture-confirmed infections. Only 4 (26.7%) of these 15 patients showed R + I E. coli in the rectal swab according to EUCAST, but 10 (66.7%) using the ECOFF cutoff. Rectal E. coli CIP R + I by the EUCAST clinical breakpoints associated with infectious complications with OR 5.7 (95% CI 1.5–21.8, P = 0.005) and ECOFF R E. coli by OR 10.7 (95% CI 3.0–37.6, P < 0.001). Men carrying rectal E. coli with moderately lowered CIP susceptibility (MIC > ECOFF 0.064 mg/l) were identified and, interestingly, they showed a high risk of developing infectious symptoms after the biopsy. This explains why some men develop infectious complications despite appropriate antibiotics before prostatic biopsies. Trial registration: NCT02140502

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dy GW, Gore JL, Forouzanfar MH, Naghavi M, Fitzmaurice C (2017) Global burden of urologic cancers, 1990–2013. Eur Urol 71:437–446

    Article  PubMed  Google Scholar 

  2. Vasarainen H, Lokman U, Ruutu M, Taari K, Rannikko A (2012) Prostate cancer active surveillance and health-related quality of life: results of the Finnish arm of the prospective trial. BJU Int 109:1614–1619

    Article  PubMed  Google Scholar 

  3. Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P et al (2016) The ProtecT trial: 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 375:1415–1424

    Article  PubMed  Google Scholar 

  4. Ehdaie B, Vertosick E, Spaliviero M, Giallo-Uvino A, Taur Y, O'Sullivan M et al (2014) The impact of repeat biopsies on infectious complications in men with prostate cancer on active surveillance. J Urol 191:660–664

    Article  PubMed  Google Scholar 

  5. Lindstedt S, Lindström U, Ljunggren E, Wullt B, Grabe M (2006) Single-dose antibiotic prophylaxis in core prostate biopsy: impact of timing and identification of risk factors. Eur Urol 50:832–837

    Article  PubMed  Google Scholar 

  6. Wegenlehner F, van Oostrum E, Tenke P, Tandogdu Z, Cek M et al (2013) Infective complications after prostate biopsy: outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, a prospective multinational multicentre prostate biopsy study. Eur Urol 63:521–527. https://doi.org/10.1016/j.eururo.2012.06.003

    Article  Google Scholar 

  7. Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH et al (2013) Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 189:S12–S18

    Article  PubMed  Google Scholar 

  8. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). https://ecdc.europa.eu/ Accessed 22 Nov 2017

  9. Wagenlehner FM, Pilatz A, Waliszewski P, Weidner W, Johansen TE (2014) Reducing infection rates after prostate biopsy. Nat Rev Urol 11:80–86

    Article  PubMed  Google Scholar 

  10. Zowawi HM, Harris PN, Roberts MJ, Tambyah PA, Schembri MA, Pezzani MD et al (2015) The emerging threat of multidrug-resistant Gram-negative bacteria in urology. Nat Rev Urol 12:570–584

    Article  CAS  PubMed  Google Scholar 

  11. Liss MA, Johnson JR, Porter SB, Johnston B, Clabots C, Gillis K et al (2015) Clinical and microbiological determinants of infection after transrectal prostate biopsy. Clin Infect Dis 60:979–987

    Article  CAS  PubMed  Google Scholar 

  12. Ricciardi W, Giubbini G, Laurenti P (2016) Surveillance and control of antibiotic resistance in the Mediterranean region. Mediterr J Hematol Infect Dis 1(8):e2016036. https://doi.org/10.4084/MJHID.2016.036

    Article  Google Scholar 

  13. Liss MA, Kim W, Moskowitz D, Szabo RJ (2015) Comparative effectiveness of targeted vs empirical antibiotic prophylaxis to prevent sepsis from transrectal prostate biopsy: a retrospective analysis. J Urol 194:397–402

    Article  CAS  PubMed  Google Scholar 

  14. Marino K, Parlee A, Orlando R, Lerner L, Strymish J, Gupta K (2015) Comparative effectiveness of single versus combination antibiotic prophylaxis for TRUS-biopsy. Antimicrob Agents Chemother 59:7273–7275

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Rudzinski JK, Kawakami J (2014) Incidence of infectious complications following transrectal ultrasound-guided prostate biopsy in Calgary, Alberta, Canada: a retrospective population-based analysis. Can Urol Assoc J 8:301–305

    Article  Google Scholar 

  16. Lahdensuo K, Rannikko A, Anttila VJ, Erickson A, Pätäri-Sampo A, Rautio M (2016) Increase of prostate biopsy-related bacteremic complications in southern Finland, 2005–2013: a population-based analysis. Prostate Cancer Prostatic Dis 19:417–422

    Article  CAS  PubMed  Google Scholar 

  17. Farrell JJ, Hicks JL, Wallace SE, Seftel AD (2017) Impact of preoperative screening for rectal colonization with fluoroquinolone-resistant enteric bacteria on the incidence of sepsis following transrectal ultrasound guided prostate biopsy. Res Rep Urol 24:37–41

    Google Scholar 

  18. Fahmy A, Rhashad H, Mohi M, Elabbadie A, Kotb A (2016) Optimizing prophylactic antibiotic regimen in patients admitted for transrectal ultrasound-guided prostate biopsies: a prospective randomized study. Prostate Int 4:113–117

    Article  PubMed  PubMed Central  Google Scholar 

  19. EUCAST Clinical breakpoints http://www.eucast.org/clinical_breakpoints/ Accessed 22 Nov 2017

  20. Liss MA, Peeples AN, Peterson EM (2011) Detection of fluoroquinolone-resistant organisms from rectal swabs by use of selective media prior to a transrectal prostate biopsy. J Clin Microbiol 49:1116–1118

    Article  PubMed  PubMed Central  Google Scholar 

  21. Taylor AK, Zembower TR, Nadler RB, Scheetz MH, Cashy JP, Bowen D et al (2012) Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol 187:1275–1279

    Article  CAS  PubMed  Google Scholar 

  22. Taylor S, Margolick J, Abughosh Z, Goldenberg SL, Lange D, Bowie WR et al (2013) Ciprofloxacin resistance in the faecal carriage of patients undergoing transrectal ultrasound guided prostate biopsy. BJU Int 111:946–953

    Article  CAS  PubMed  Google Scholar 

  23. Batura D, Rao GG, Nielsen PB (2010) Prevalence of antimicrobial resistance in intestinal flora of patients undergoing prostatic biopsy: implications for prophylaxis and treatment of infections after biopsy. BJU Int 106:1017–1020

    Article  CAS  PubMed  Google Scholar 

  24. Chan ES, Lo KL, Ng CF, Hou SM, Yip SK (2012) Randomized controlled trial of antibiotic prophylaxis regimens for transrectal ultrasound-guided prostate biopsy. Chin Med J 125:2432–2435

    CAS  PubMed  Google Scholar 

  25. Cussans A, Somani BK, Basarab A, Dudderidge TJ et al (2016) The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography-guided prostate biopsy in reducing infection rates: a systematic review. BJU Int 117:725–731

    Article  CAS  PubMed  Google Scholar 

  26. Boeri L, Fontana M, Gallioli A, Zanetti SP, Catellani M, Longo F et al (2017) Rectal culture-guided targeted antimicrobial prophylaxis reduces the incidence of post-operative infectious complications in men at high risk for infections submitted to transrectal ultrasound prostate biopsy—results of a cross-sectional study. PLoS One 12:e0170319

    Article  PubMed  PubMed Central  Google Scholar 

  27. Liss MA, Ehdaie B, Loeb S, Meng MV, Raman JD, Spears V et al (2017) An update of the American Urological Association white paper on the prevention and treatment of the more common complications related to prostate biopsy. J Urol 198:329–333

    Article  PubMed  Google Scholar 

  28. Tukenmez Tigen E, Tandogdu Z, Ergonul O, Altinkanat G, Gunaydin B, Ozgen M et al (2014) Outcomes of fecal carriage of extended-spectrum β-lactamase after transrectal ultrasound-guided biopsy of the prostate. Urology 84:1008–1015

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank our study nurses Merja Rignell and Katja Kiianlinna for their valuable assistance throughout the study.

Funding

This work was supported by Competitive State Research funding (TYH2013345 and TYH2015313 to A. R.), a grant from the Finnish Cancer Society (7553 to A. R.), and a grant from the Finnish Urological Association (2016 and 2017 to I. K.).

Author information

Authors and Affiliations

  1. Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Inari Kalalahti, Kanerva Lahdensuo, Henrikki Santti & Antti Rannikko

  2. Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Kaisa Huotari

  3. Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, HUSLAB, Helsinki, Finland

    Eveliina Tarkka & Anu Pätäri-Sampo

Authors
  1. Inari Kalalahti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaisa Huotari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kanerva Lahdensuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eveliina Tarkka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Henrikki Santti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antti Rannikko
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anu Pätäri-Sampo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Inari Kalalahti.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The ethics committee of the Department of Surgery at Helsinki University Hospital approved the study and the trial was registered at ClinicalTrial.Gov (NCT02140502).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kalalahti, I., Huotari, K., Lahdensuo, K. et al. Rectal E. coli above ciprofloxacin ECOFF associate with infectious complications following prostate biopsy. Eur J Clin Microbiol Infect Dis 37, 1055–1060 (2018). https://doi.org/10.1007/s10096-018-3217-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-018-3217-7

Keywords

Search

Navigation