title: Positive culture for extended-spectrum β-lactamase during acute prostatitis after prostate biopsy is a risk factor for progression to chronic prostatitis.
abstract: OBJECTIVE
  To analyze whether strains positive for extended-spectrum β-lactamase (ESBL) affected the clinical course and progression to chronic prostatitis in patients with postbiopsy acute prostatitis.
  
  
  METHODS
  From 2002 to 2011, 3657 patients underwent transrectal ultrasound-guided biopsy of the prostate, and 33 patients with acute prostatitis were enrolled. Acute prostatitis was defined as a fever greater than 38°C, pyuria, and tenderness on digital rectal examination. Urine and blood cultures were tested for antibiotic susceptibility. Laboratory and clinical variables according to the presence of ESBL were analyzed.
  
  
  RESULTS
  Blood or urine culture was positive in 23 patients. The most common strain was Escherichia coli. Sixteen patients showed ESBL-positive and 18 patients were quinolone-resistant. Thirteen of 16 patients with ESBL-positive strains showed quinolone resistance, and 13 of 18 patients with quinolone resistance were ESBL-positive (P = .621). Besides imipenem, all ESBL-positive patients were susceptible to amikacin and were highly susceptible to cefoxitin and amoxicillin/clavulanic acid. The prevalence of ESBL-positive strains has tended to increase since 2006. Patients with ESBL had higher peak fever, white blood cell count, absolute neutrophil count, and longer duration of fever and hospitalization. The progression rate to chronic prostatitis was significantly higher in ESBL-positive patients (4/16 vs 0/17, P = .044).
  
  
  CONCLUSIONS
  Since 2006, ESBL strains have been increasing, and the presence of ESBL showed more detrimental effects on the clinical course of the patients, resulting in a higher rate of progression to chronic prostatitis.
authors.affiliation: Department of Urology, Korea University Medical Center, Seoul, Korea.
authors.forename: Mi Mi
authors.initials: MM
authors.lastname: Oh
authors.forename: Ji Yun
authors.initials: JY
authors.lastname: Chae
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Cheol Yong
authors.initials: CY
authors.lastname: Yoon
authors.forename: Min Gu
authors.initials: MG
authors.lastname: Park
authors.forename: Du Geon
authors.initials: du G
authors.lastname: Moon
mesh_terms: D000368:Aged; D000583:Amikacin / Q000494:pharmacology; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001769:Blood / Q000382:microbiology; D002440:Cefoxitin / Q000494:pharmacology; D018450:Disease Progression; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology*; D004927:Escherichia coli Infections / Q000382:microbiology*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects; D015378:Imipenem / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011472:Prostatitis / Q000382:microbiology*; D015363:Quinolones / Q000494:pharmacology; D014556:Urine / Q000382:microbiology; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D015363:Quinolones; D002440:Cefoxitin; D015378:Imipenem; D019980:Amoxicillin-Potassium Clavulanate Combination; D000583:Amikacin; D001618:beta-Lactamases