title: The incidence of fluoroquinolone resistant infections after prostate biopsy--are fluoroquinolones still effective prophylaxis?
abstract: OBJECTIVE
  Fluoroquinolones have been shown to decrease infective complications after prostate biopsy. However, fluoroquinolone resistance is emerging. We quantified contemporary rates of infective complications and the incidence of fluoroquinolone resistant infections after prostate biopsy under fluoroquinolone prophylaxis.
  
  
  METHODS
  We retrospectively evaluated the records of 1,273 patients who underwent prostate biopsy at New York Harbor Veterans Affairs Hospital from January 2004 to December 2006. Patients received levofloxacin or gatifloxacin. Using the Veterans Affairs computerized patient record system we reviewed all patient visits within 1 month after prostate biopsy. Visits were queried for infective symptoms. Positive cultures were evaluated for resistance patterns. The annual and overall incidence of infective complications and fluoroquinolone resistant infections was calculated.
  
  
  RESULTS
  Of 1,273 patients 31 (2.4%) presented with infective symptoms after biopsy. The overall incidence of fluoroquinolone resistant infections was 1.2% (15 cases). When stratified by year, there were statistically significant increases in the incidence of infective complications and fluoroquinolone resistance from 2004 to 2006. Of the positive cultures those from 89% of patients yielded Escherichia coli and 90% were fluoroquinolone resistant. Fluoroquinolone resistant E. coli were also resistant to gentamicin in 22% of cases, trimethoprim/sulfamethoxazole in 44%, piperacillin in 72% and ampicillin in 94%. However, 100% sensitivity was demonstrated for amikacin, ceftazidime and ceftriaxone.
  
  
  CONCLUSIONS
  Fluoroquinolones are still effective as antibiotic prophylaxis for prostate biopsies but there is an increase in infective complications and fluoroquinolone resistance. When patients present with post-prostate biopsy infective symptoms, almost 50% are associated with fluoroquinolone resistant pathogens. Empirical treatment with ceftriaxone, ceftazidime or amikacin should be initiated until culture specific therapy can be implemented.
authors.affiliation: State University of New York Downstate Medical School, Brooklyn, New York, USA. joseph.feliciano@downstate.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Feliciano
authors.forename: Ervin
authors.initials: E
authors.lastname: Teper
authors.forename: Michael
authors.initials: M
authors.lastname: Ferrandino
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Macchia
authors.forename: William
authors.initials: W
authors.lastname: Blank
authors.forename: Ivan
authors.initials: I
authors.lastname: Grunberger
authors.forename: Ivan
authors.initials: I
authors.lastname: Colon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D001706:Biopsy / Q000009:adverse effects*; D018890:Chemoprevention; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000382:microbiology* / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones