title: Bacteriuria and antibiotic resistance in catheter urine specimens following radical prostatectomy.
abstract: OBJECTIVE
  There are increasing reports of infectious complications following prostate biopsy due to fluoroquinolone resistance. To determine infectious complications at catheter removal following radical prostatectomy (RP), another setting in daily urological practice where fluoroquinolone prophylaxis is frequently used.
  
  
  METHODS
  We prospectively examined urine culture results collected from 334 RP patients immediately prior to catheter removal. Patients received prophylactic antibiotics 1 day before, the day of, and for 5 days after catheter removal. Culture results were reviewed for bacterial species and antimicrobial susceptibilities. Patients with positive urine cultures resistant to the prophylactic antibiotic were switched to culture-specific antibiotic therapy and underwent follow-up culture. The frequency of urinary tract infection (UTI), complications, additional antibiotic therapy, and repeat urine cultures was determined within 60 days.
  
  
  RESULTS
  Of the 334 patients identified, 203 (61%) had cultures with no bacterial growth, and 48 (14%) had colony counts of <1,000 bacteria or Candida albicans and received no further antibiotics. The remaining 83 (25%) had positive culture results, of which 7% were resistant to ciprofloxacin. Twenty-four bacterial species were identified, with Pseudomonas aeruginosa (5%) Escherichia coli (4%), and Staphylococcus epidermidis (3%) being the most frequent. Only two (0.6%) men developed clinical symptoms consistent with UTI (i.e., suprapubic pain, fever) prior to catheter removal, and no serious complications occurred.
  
  
  CONCLUSIONS
  A substantial proportion of RP patients have positive urine cultures at the time of catheter removal, despite the administration of prophylactic fluoroquinolone antibiotics. Potentially virulent organisms are commonly cultured, and ciprofloxacin resistance is frequent. However, outcomes are favorable when culture-specific oral antibiotic therapy is initiated.
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Banks
authors.forename: Barry B
authors.initials: BB
authors.lastname: McGuire
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
authors.forename: Sanjina
authors.initials: S
authors.lastname: Shrestha
authors.forename: Brian T
authors.initials: BT
authors.lastname: Helfand
authors.forename: William J
authors.initials: WJ
authors.lastname: Catalona
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000145:classification; D019072:Antibiotic Prophylaxis / Q000379:methods; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001437:Bacteriuria / Q000209:etiology / Q000382:microbiology*; D002176:Candida albicans / Q000302:isolation & purification; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000302:isolation & purification; D024841:Fluoroquinolones / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D014552:Urinary Tract Infections / Q000209:etiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones