title: Bacterial sepsis following prostatic biopsy.
abstract: OBJECTIVE
  Despite the recent innovations, complications of prostate biopsy can occur. The aim of this study was a prospective monitoring of major septic complications occurring after transrectal prostate biopsy, to describe their causing agents, to report the clinical course of these patients, and to give guidelines based on our personal experience.
  
  
  METHODS
  This prospective study was carried out between January 2009 and September 2010. Complications were evaluated by telephone interviews.
  
  
  RESULTS
  Between January 2009 and September 2010, 447 (96.5%) completed the telephone interview. Urosepsis occurred in ten patients (2.2%) and in three cases evolved into septic shock. Of these ten patients, nine had a positive blood culture, of whom eight for Escherichia coli and one for Aeromonas hydrophila, Aeromonas caviae, and Aeromonas sobria. In seven cases, the E. coli isolated were resistant to fluoroquinolone and six produced an extended spectrum beta-lactamase. Six E. coli were classified as multidrug-resistant organisms. Of the 10 patients, one died after the onset of multiorgan failure. For the other nine, the mean time spent in the hospital was 9 days (range, 6-15 days).
  
  
  CONCLUSIONS
  Escherichia coli are developing new drug resistances. Early recognition of patients who harbor MDRO E. coli in their rectum or in the urine could be an important strategy for preventing sepsis. If a patient who has recently undergone transrectal prostate biopsy shows clinical signs of sepsis in the 48 h, a multiresistant E. coli infection must be suspected. The patient must be admitted urgently to the hospital, and carbapenem antibiotic therapy should be started.
authors.affiliation: Urology Department, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Carmignani
authors.forename: Stefano
authors.initials: S
authors.lastname: Picozzi
authors.forename: Matteo
authors.initials: M
authors.lastname: Spinelli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Pierro
authors.forename: Gabriella
authors.initials: G
authors.lastname: Mombelli
authors.forename: Ercole
authors.initials: E
authors.lastname: Negri
authors.forename: Milvana
authors.initials: M
authors.lastname: Tejada
authors.forename: Paola
authors.initials: P
authors.lastname: Gaia
authors.forename: Elena
authors.initials: E
authors.lastname: Costa
authors.forename: Augusto
authors.initials: A
authors.lastname: Maggioni
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001707:Biopsy, Needle / Q000009:adverse effects*; D004926:Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents