title: Baseline prevalence of antimicrobial resistance and subsequent infection following prostate biopsy using empirical or altered prophylaxis: A bias-adjusted meta-analysis.
abstract: Transrectal ultrasound-guided prostate biopsy (TRUSPB) is a commonly performed urological procedure. Recent studies suggest that pre-biopsy screening for fluoroquinolone-resistant (FQ-R) pathogens may be useful in reducing post-biopsy infections. We sought to determine the baseline prevalence of fluoroquinolone (FQ) resistance in rectal flora and to investigate the relationship between pre-biopsy carriage of FQ-R pathogens and the risk of post-TRUSPB infection. Electronic databases were searched for related literature. Studies were assessed for methodological quality and comparable outcomes prior to meta-analysis (using quality- and random-effects models). Nine studies, representing 2541 patients, were included. The prevalence of FQ resistance was higher (20.4%, 95% CI 18.2-22.6%) in rectal cultures obtained following FQ-based prophylaxis compared with those obtained before (12.8%, 95% CI 10.7-15.0%). Overall infection rates in patients using empirical prophylaxis were higher (3.3%, 95% CI 2.6-4.2%) than in those using altered (targeted/protocol) regimens (0.3%, 95% CI 0-0.9%). Higher infection rates were seen in men with FQ-R rectal cultures (7.1%, 95% CI 4.0-10.5%) than in those with FQ-sensitive (FQ-S) rectal cultures (1.1%, 95% CI 0.5-1.8%). For every 14 men with FQ-R rectal cultures, one additional infection was observed compared with men with FQ-S rectal cultures. Prior FQ use and prior genitourinary infection were significant risk factors for FQ-R colonisation. FQ resistance in rectal flora is a significant predictor of post-TRUSPB infection and may require re-assessment of empirical antimicrobial prophylaxis methods. Altered prophylaxis based on rectal culturing prior to TRUSPB may reduce morbidity and potentially provide economic benefits to health services.
authors.affiliation: Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. Electronic address: m.roberts2@uq.edu.au.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Roberts
authors.affiliation: Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Clinical Microbiology, Auckland District Health Board, New Zealand; Institute of Environmental Science and Research, Wellington, New Zealand.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Williamson
authors.affiliation: Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Hadway
authors.affiliation: School of Population Health, The University of Queensland, Brisbane, Queensland, Australia; Department of Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Suhail A R
authors.initials: SA
authors.lastname: Doi
authors.affiliation: Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia; Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gardiner
authors.affiliation: Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia; Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D019072:Antibiotic Prophylaxis; D001706:Biopsy / Q000009:adverse effects*; D004352:Drug Resistance, Microbial; D024841:Fluoroquinolones / Q000494:pharmacology; D006801:Humans; D008297:Male; D015995:Prevalence; D011467:Prostate / Q000166:cytology*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000517:prevention & control; D036761:Ultrasound, High-Intensity Focused, Transrectal; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: Antimicrobial prophylaxis; Fluoroquinolone resistance; Post-surgical complications; Prostate biopsy; Rectal culture