title: Outbreak of fluoroquinolone-resistant Escherichia coli infections after transrectal ultrasound-guided biopsy of the prostate.
abstract: METHODS
  We conducted an investigation after identifying a cluster of 4 serious infections following transrectal ultrasound-guided biopsy of the prostate (TRUBP) during a 2-month period.
  
  
  METHODS
  Veterans Affairs medical center.
  
  
  METHODS
  Patients with urinary tract infection (UTI) after TRUBP and time-matched controls with no evidence of infection.
  
  
  METHODS
  The incidence of UTI within 30 days after TRUBP was calculated from 2002 through 2010. We evaluated the correlation between infection with fluoroquinolone-resistant gram-negative bacilli (GNB) and fluoroquinolone resistance in outpatient Escherichia coli urinary isolates and performed a case-control study to determine risk factors for infection with fluoroquinolone-resistant GNB. Processes for TRUBP prophylaxis, procedures, and equipment sterilization were reviewed.
  
  
  RESULTS
  An outbreak of UTI due to fluoroquinolone-resistant E. coli after TRUBP began 2 years before the cluster was identified and was correlated with increasing fluoroquinolone resistance in outpatient E. coli. No deficiencies were identified in equipment processing or biopsy procedures. Fluoroquinolone-resistant E. coli UTI after TRUBP was independently associated with prior infection with fluoroquinolone-resistant GNB (adjusted odds ratio, 20.8; P=.005). A prediction rule including prior UTI, hospitalization in the past year, and previous infection with fluoroquinolone-resistant GNB identified only 17 (49%) of 35 cases.
  
  
  CONCLUSIONS
  The outbreak of fluoroquinolone-resistant E. coli infections after TRUBP closely paralleled rising rates of fluoroquinolone resistance among outpatient E. coli isolates. The delayed detection of the outbreak and the absence of sensitive predictors of infection suggest that active surveillance for infection after TRUBP is necessary in the context of increasing fluoroquinolone resistance in the United States.
authors: Department of Infectious Diseases, University Hospitals of Cleveland, Cleveland, Ohio, USA.
authors: Donald
authors: D
authors: Dumford
authors: Nuntra
authors: N
authors: Suwantarat
authors: Vineet
authors: V
authors: Bhasker
authors: Sirisha
authors: S
authors: Kundrapu
authors: Trina F
authors: TF
authors: Zabarsky
authors: Paul
authors: P
authors: Drawz
authors: Hui
authors: H
authors: Zhu
authors: Curtis J
authors: CJ
authors: Donskey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D024841:Fluoroquinolones / Q000494:pharmacology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011467:Prostate / Q000473:pathology; D018709:Statistics, Nonparametric; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D024841:Fluoroquinolones