title: Rectal cultures before transrectal ultrasound-guided prostate biopsy reduce post-prostatic biopsy infection rates.
abstract: OBJECTIVE
  To test our hypothesis that a targeted rectal screening protocol before transrectal ultrasound (TRUS)-guided biopsy would potentiate streamlined prophylaxis, thereby reducing postbiopsy infectious rates while minimizing unnecessary broad-spectrum antibiotic use. To this end, we instituted preprocedure rectal cultures in an effort to identify fluoroquinolone (FQ)- resistant flora using selective media to optimally direct targeted prophylactic antibiotic administration. The inexorably increasing prevalence of multidrug-resistant microorganisms, notably extended spectrum beta lactamase (ESBL)-producing and FQ-resistant Enterobacteriaceae has increased the post-TRUS prostatic biopsy infection rates, including life-threatening sepsis.
  
  
  METHODS
  A total of 235 rectal swabs were obtained and plated directly onto MacConkey agar plates containing 10-μg/mL ciprofloxacin. Following the screening procedure, antimicrobial susceptibility results were used to develop a customized antibiotic prophylaxis regimen to be administered before biopsy. Following the biopsy procedure, the patients were seen in follow-up within 7 days, and information was gathered on potential adverse effects, clinical appointments for infections, and potential antibiotics received.
  
  
  RESULTS
  Thirty-two-patients (14%) had FQ-resistant isolates (most Escherichia coli), and 3 (1.3%) were ESBL-producing isolates. There were no infectious complications identified in this period, (compared with 3 septic complications among 103 biopsies in the 4 months preceding the study).
  
  
  CONCLUSIONS
  Rectal cultures obtained before TRUS biopsy, using selective media to identify FQ-resistant Enterobacteriaceae, facilitate targeted antibiotic prophylaxis, and appear to be highly efficacious in reducing infectious complications.
authors.affiliation: Infectious Disease Division, Naval Hospital San Diego, San Diego, California 92134-1005, USA. Chris.duplessis@waldenu.edu
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Duplessis
authors.forename: Mary
authors.initials: M
authors.lastname: Bavaro
authors.forename: Mark P
authors.initials: MP
authors.lastname: Simons
authors.forename: Charles
authors.initials: C
authors.lastname: Marguet
authors.forename: Michael
authors.initials: M
authors.lastname: Santomauro
authors.forename: Brian
authors.initials: B
authors.lastname: Auge
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Collard
authors.forename: Joshua
authors.initials: J
authors.lastname: Fierer
authors.forename: James
authors.initials: J
authors.lastname: Lesperance
mesh_terms: D019072:Antibiotic Prophylaxis; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D004352:Drug Resistance, Microbial; D004755:Enterobacteriaceae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000517:prevention & control*; D004926:Escherichia coli / Q000187:drug effects; D024841:Fluoroquinolones / Q000494:pharmacology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D015999:Multivariate Analysis; D011467:Prostate / Q000473:pathology; D012007:Rectum / Q000000981:diagnostic imaging / Q000382:microbiology*; D014463:Ultrasonography
chemical_list: D024841:Fluoroquinolones