title: Sepsis due to fluoroquinolone-resistant Escherichia coli after transrectal ultrasound-guided prostate needle biopsy.
abstract: OBJECTIVE
  To report a series of patients with sepsis due to fluoroquinolone-resistant Escherichia coli after prostate needle biopsy across 4 hospitals in southern California.
  
  
  METHODS
  Five patients presented with fever and blood cultures positive for fluoroquinolone-resistant E. coli after prostate needle biopsy with pre-procedure fluoroquinolone antimicrobial prophylaxis. The cases are described and the published data reviewed.
  
  
  RESULTS
  Of the 5 patients, 1 was treated at Hoag Memorial Hospital in 2008, 2 were treated at the Long Beach Veterans Affairs Medical Center, 1 was treated at Kaiser Permanente Hospital in 2007, and 1 presented to University of California, Irvine, Medical Center in 2006. All patients received an oral fluoroquinolone antibiotic the morning of or 1 hour before biopsy. Of the 5 patients, 4 also received gentamicin intramuscularly before biopsy.
  
  
  CONCLUSIONS
  The estimated incidence of sepsis was 0.1%-0.9%, assuming patients reported to the hospital at which the biopsy was performed. From a review of the published data, we recommend a fluoroquinolone antibiotic before and after biopsy for < or =24 hours. From our findings, if the patient has taken a fluoroquinolone antibiotic in the past 8 months, a second- or third-generation cephalosporin should be used or an aminoglycoside (1.5-2 mg/kg intramuscularly) with metronidazole or clindamycin. A carbapenem should be substituted if the patient has a history of infections with extended-spectrum beta-lactamase producers. Cases of fluoroquinolone-resistant E. coli should be tracked in a nationalized database.
authors.affiliation: Department of Urology, University of California, Irvine, 92868, USA. jlyoung@uci.edu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Young
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Szabo
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001707:Biopsy, Needle / Q000009:adverse effects*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000209:etiology*; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology; D018084:Ultrasonography, Interventional
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones