title: Febrile reactions after transrectal ultrasound-guided prostatic biopsy: a retrospective study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the incidence and clinical presentation in patients with hospital admission owing to febrile infections after transrectal ultrasound-guided prostate biopsies.
  
  
  METHODS
  The case histories of the 57 patients (3.5%) who, between January 2006 and December 2009, were admitted owing to a febrile infection secondary to the 1633 transrectal prostate biopsies performed during the period were retrospectively analysed. Norfloxacin 400 mg ? 2 was given for 3 days as prophylaxis starting just before or within 10 min of biopsy.
  
  
  RESULTS
  Quinolone-resistant Escherichia coli was isolated from blood cultures in 43% of the patients (n = 15) presenting with fever between 24 and 48 h postbiopsy. The urine culture was positive in 13% and no patient had symptoms suggestive of a urinary tract infection (UTI). In patients presenting after 48 h (n = 42), quinolone-resistant E. coli was never isolated from blood; E. coli was cultured from urine in 45% of the patients and in 48% it was associated with UTI symptoms.
  
  
  CONCLUSIONS
  The finding that early postbiopsy fever was often associated with a quinolone-resistant E. coli bacteraemia and never with UTI symptoms, as opposed to late-onset fever, where such symptoms were common and quinolone-resistant E. coli was rarely detected, suggests divergent pathogenic mechanisms underpinning early- and late-onset febrile reactions. These findings have implications for how antibiotic prophylaxis should be given.
authors.affiliation: Departments of Urology, Research and Development, and Clinical Microbiology, Unilabs Skaraborgs Sjukhus, Skövde, Sweden. hans.hedelin@vgregion.se
authors.forename: Hans
authors.initials: H
authors.lastname: Hedelin
authors.forename: Berndt E B
authors.initials: BE
authors.lastname: Claesson
authors.forename: Alexander
authors.initials: A
authors.lastname: Wilpart
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001706:Biopsy / Q000009:adverse effects*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000097:blood / Q000382:microbiology* / Q000652:urine; D005334:Fever / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D009643:Norfloxacin / Q000627:therapeutic use*; D011467:Prostate / Q000473:pathology*; D012189:Retrospective Studies; D013997:Time Factors; D018084:Ultrasonography, Interventional
chemical_list: D000900:Anti-Bacterial Agents; D009643:Norfloxacin