title: Early infectious complications with transponder placement for external beam radiation therapy for prostate cancer.
abstract: What's known on the subject? and What does the study add? Little has been published related to transponders per se, but a number of studies relating to prostate biopsy-related infections and the increased incidence of quinolone-resistant Escherichia coli have been published. The study alerts the practising urologist to the risk of quinolone-resistant E. coli in the setting of transrectally placed transponders. Furthermore, it proposes an antibiotic regimen that should reduce this risk.
  
  
  OBJECTIVE
  To report our series of early infectious complications after placement of Calypso(®) transponders (Calypso Medical, Seattle, WA, USA) into the prostate.
  
  
  METHODS
  Between February 2008 and October 2010, 50 consecutive patients underwent placement of Calypso(®) transponders into the prostate. Patients were administered ciprofloxacin 500 mg every 12 h, starting the night before the procedure and for 2 days after the procedure. Data were collected via chart review, and complications were classified according to the Clavien classification system.
  
  
  RESULTS
  Of the 50 patients undergoing the procedure, five (10%) developed infectious complications, and three (6%) developed a grade II complication with a UTI requiring antibiotic therapy. One patient (2%) developed a grade IIIb complication with an epidural abscess and osteomyelitis of the lumbar vertebrae requiring open debridement and a lumbar fusion. One patient (2%) developed a prostatic abscess with methicillin-resistant Staphylococcus aureus and subsequently died of an unrelated lower GI bleed. In 4/50 patients (8%), a culture confirmed the responsible bacteria, of which three cases were quinolone-resistant Escherichia coli.
  
  
  CONCLUSIONS
  As with prostate biopsy, the emergence of quinolone-resistant E. coli remains a challenging infectious complication with transrectal prostate procedures. We propose an alternative strategy of double antibiotic coverage with one dose of oral ciprofloxacin 500 mg and gentamicin 80 mg i.m. before this procedure.
authors.affiliation: Glickman Urologic and Kidney Insititute, Cleveland, OH, USA. berglur@ccf.org
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Berglund
authors.forename: Osama
authors.initials: O
authors.lastname: Zaytoun
authors.forename: Richard
authors.initials: R
authors.lastname: Thousand
authors.forename: Kevin
authors.initials: K
authors.lastname: Stephans
authors.forename: Rahul
authors.initials: R
authors.lastname: Tendulkar
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects / Q000295:instrumentation; D012189:Retrospective Studies