title: Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms.
abstract: OBJECTIVE
  To evaluate the effect of long-term fluoroquinolone treatment before the biopsy in terms of post procedure sepsis. Three-week fluoroquinolone management before the biopsy may lower serum prostate specific antigen (PSA) levels and prevent unnecessary biopsies.
  
  
  METHODS
  A total of 558 patients were referred to our clinic for transrectal ultrasound (TRUS)-guided prostate biopsy. Of the patients, 205 had received levofloxacin 500 mg once a day for 3 weeks before the biopsy to lower the serum PSA levels (group 1). A total of 353 patients had not received any antibiotics before the procedure (group 2). In terms of the postbiopsy sepsis rate, group 1 and group 2 as well as patients who underwent biopsies in the early period and the latter period of the study were compared.
  
  
  RESULTS
  Sepsis was diagnosed in 17 patients (3.0%) after biopsy. Of these patients, 11 (5.4%) and 6 (1.7%) were in group 1 and group 2, respectively (P = .0297, OR: 3.28, 95% CI: 1.10-10.13). Sepsis was diagnosed in 7 patients (1.9%) and 10 patients (5.0%) in the early and the latter period of the study, respectively (P = .0771, OR: 0.38, 95% CI: .13-1.09). Escherichia coli was the causative agent in all patients with a positive culture. In addition, 1 patient also had meticillin-resistant Staphylococcus epidermidis (MRSE). All of the E. coli isolates were resistant to fluoroquinolones, and 55.6% were positive for extended spectrum β-lactamases (ESBL).
  
  
  CONCLUSIONS
  Long-term fluoroquinolone use to prevent unnecessary prostate biopsy may result in postbiopsy sepsis caused by fluoroquinolone resistant microorganisms.
authors.affiliation: Department of Urology, Zonguldak Karaelmas University School of Medicine, Zonguldak, Turkey. akdumanb@yahoo.com
authors.forename: Bülent
authors.initials: B
authors.lastname: Akduman
authors.forename: Deniz
authors.initials: D
authors.lastname: Akduman
authors.forename: Hüsnü
authors.initials: H
authors.lastname: Tokgöz
authors.forename: Bülent
authors.initials: B
authors.lastname: Erol
authors.forename: Tuğrul
authors.initials: T
authors.lastname: Türker
authors.forename: Ferruh
authors.initials: F
authors.lastname: Ayoğlu
authors.forename: Necmettin Aydın
authors.initials: NA
authors.lastname: Mungan
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D001707:Biopsy, Needle; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000139:chemically induced* / Q000453:epidemiology*; D013997:Time Factors
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D064704:Levofloxacin; D015242:Ofloxacin