title: Prevalence and significance of fluoroquinolone resistant Escherichia coli in patients undergoing transrectal ultrasound guided prostate needle biopsy.
abstract: OBJECTIVE
  We estimated the prevalence of fluoroquinolone resistant Escherichia coli in patients undergoing repeat transrectal ultrasound guided prostate needle biopsy and identified high risk groups.
  
  
  METHODS
  From January 2009 to March 2010 rectal swabs of 136 men from 3 institutions undergoing transrectal ultrasound guided prostate needle biopsy were obtained. There were 33 men with no previous biopsy who served as the controls. Participants completed questionnaires and rectal swab culture was obtained just before performing the prostate biopsy. Selective media was used to specifically isolate fluoroquinolone resistant E. coli and sensitivities were obtained. The patients were contacted via telephone 7 days after the procedure for a followup questionnaire.
  
  
  RESULTS
  A total of 30 patients had cultures positive for fluoroquinolone resistant bacteria for an overall rate of 22% (95% CI 15, 29). Patients with diabetes and Asian ethnicity had higher risks of resistant rectal flora colonization (OR 2.3 and 2.8, respectively). However, differences did not reach statistical significance (p = 0.09 and p = 0.08, respectively). Patients with no prior biopsy had a positive rate of 15% (5 of 33) compared to 24% (25 of 103) in those with 1 or more prior biopsies (OR 1.8, p = 0.27). Five patients (3.6%) had post-biopsy fever while only 1 of those patients had a positive rectal swab.
  
  
  CONCLUSIONS
  Using selective media to isolate fluoroquinolone resistant E. coli from the rectum before transrectal ultrasound guided prostate biopsy, we isolated organisms in 22% of patients with a wide resistance pattern. This protocol may be used to provide information regarding targeted antibiotic prophylaxis before transrectal prostate biopsies.
authors.affiliation: Department of Urology, University of California-Irvine, Irvine, California, USA. mliss@uci.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.forename: Alexandra
authors.initials: A
authors.lastname: Chang
authors.forename: Rosanne
authors.initials: R
authors.lastname: Santos
authors.forename: Amy
authors.initials: A
authors.lastname: Nakama-Peeples
authors.forename: Ellena M
authors.initials: EM
authors.lastname: Peterson
authors.forename: Kathryn
authors.initials: K
authors.lastname: Osann
authors.forename: John
authors.initials: J
authors.lastname: Billimek
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Szabo
authors.forename: Atreya
authors.initials: A
authors.lastname: Dash
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D024841:Fluoroquinolones / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional
chemical_list: D024841:Fluoroquinolones