title: Escherichia coli bloodstream infection after transrectal ultrasound-guided prostate biopsy: implications of fluoroquinolone-resistant sequence type 131 as a major causative pathogen.
abstract: BACKGROUND
  Transrectal ultrasound-guided (TRUS) prostate biopsy is a commonly performed procedure, and fluoroquinolones are the most frequently given prophylactic antimicrobials. In the context of increasing fluoroquinolone resistance, and the international emergence of fluoroquinolone-resistant sequence type 131 (ST131) Escherichia coli, we describe a large series of E. coli bacteremia after TRUS biopsy.
  
  
  METHODS
  All male patients admitted with community-onset (CO) E. coli bacteremia from January 2006 through December 2010 were included. Patient characteristics, treatment outcomes, and rates of antimicrobial resistance were compared between patients with TRUS biopsy-related bacteremia and other male patients with CO E. coli bacteremia. Molecular typing was performed on E. coli isolates to determine phylogenetic group.
  
  
  RESULTS
  A total of 258 male patients were admitted with CO E. coli bacteremia. Of these, 47 patients (18%) were admitted after TRUS biopsy. Patients who had undergone TRUS biopsy were twice as likely to require intensive care admission (25% vs 12%) and had significantly higher rates of resistance to gentamicin (43%), trimethoprim-sulphamethoxazole (60%), and ciprofloxacin (62%) as well as all 3 agents in combination (19%). Thirty-six percent of post-TRUS biopsy patients did not receive active empirical antibiotic therapy. The ST131 clone accounted for 41% of all E. coli isolates after TRUS biopsy.
  
  
  CONCLUSIONS
  E. coli bacteremia can be a life-threatening complication of TRUS biopsy. Infecting strains are frequently multidrug-resistant and resistant to common empirical antibiotic agents. E. coli ST131 is an important cause of sepsis after TRUS biopsy. Further studies should evaluate colonization with fluoroquinolone-resistant E. coli as a risk factor for postbiopsy sepsis.
authors.affiliation: Department of Microbiology, Auckland District Health Board, New Zealand. dwilliamson@adhb.govt.nz
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Williamson
authors.forename: Sally A
authors.initials: SA
authors.lastname: Roberts
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
authors.forename: Hanna
authors.initials: H
authors.lastname: Sidjabat
authors.forename: Anna
authors.initials: A
authors.lastname: Silvey
authors.forename: Jonathan
authors.initials: J
authors.lastname: Masters
authors.forename: Michael
authors.initials: M
authors.lastname: Rice
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Freeman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods; D018890:Chemoprevention / Q000379:methods; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology*; D024841:Fluoroquinolones / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones