Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy.
OBJECTIVE
To study the clinical and bacteriologic picture of acute prostatitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli after transrectal ultrasound-guided prostate biopsy.


METHODS
The retrospective data from 1339 patients who had undergone transrectal ultrasound-guided biopsy from November 2003 to June 2008 were reviewed. An automatic biopsy gun with an 18-gauge needle was used to obtain 10-core biopsies for first biopsies and > or =12-core for repeat biopsies. These patients had received 500 mg ciprofloxacin orally twice daily for 5 days, beginning 24 hours before biopsy. All biopsies were performed as outpatient procedures.


RESULTS
Of the 1339 patients, 28 (2.1%) had acute bacterial prostatitis detected after transrectal ultrasound-guided prostate biopsy. Acute prostatitis occurred after the first biopsy in 15 patients (1.3%) and after repeat biopsy in 13 (6.8%). The patients had developed infective symptoms a mean of 3 days after transrectal ultrasound-guided prostate biopsy. Of the 28 patients, 17 (61%) had positive urine and/or blood cultures, including E. coli in 14. Of the 14 patients, 6 had acute prostatitis caused by ESBL-producing E. coli. Bacteria isolated from urine were tested for drug susceptibility to a wide range of antibiotics. All patients with ESBL-producing E. coli were treated with imipenem. The bacteria detected in these urine cultures were resistant to ciprofloxacin, ceftriaxone, sulbactam/ampicillin, and cefazolin. Imipenem and piperacillin-tazobactam were the most active agents against ESBL-producing E. coli. ESBL-producing isolates had a significant reduction in activity for most antimicrobial agents, including fluoroquinolones and amikacin.


CONCLUSIONS
The prompt initiation of effective antimicrobial treatment is essential in patients with ESBL-producing E. coli, and empirical decisions must be determined by knowledge of the local distribution of pathogens and their susceptibility.
Ozden
Ender
E
Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey. eozden@omu.edu.tr
Bostanci
Yakup
Y
Yakupoglu
Kamil Y
KY
Akdeniz
Ekrem
E
Yilmaz
Ali F
AF
Tulek
Necla
N
Sarikaya
Saban
S
D000208:Acute Disease; D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D004926:Escherichia coli / Q000201:enzymology*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D011472:Prostatitis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D012007:Rectum; D012189:Retrospective Studies; D001618:beta-Lactamases
D001618:beta-Lactamases