title: Use of outpatient parenteral antimicrobial therapy for transrectal ultrasound-guided prostate biopsy prophylaxis in the setting of community-associated multidrug-resistant Escherichia coli rectal colonization.
abstract: OBJECTIVE
  To study the use of ertapenem delivered in an outpatient parenteral antimicrobial therapy (OPAT) hospital-based unit setting for targeted transrectal ultrasound-guided prostate biopsy (TRUSPBx) prophylaxis in the setting of multidrug-resistant (MDR) Escherichia coli rectal colonization. E coli is the pathogen most commonly associated with post-TRUSPBx complications, and there is increasing prevalence of community-associated MDR E coli.
  
  
  METHODS
  Prospective data analysis of all patients admitted to the OPAT unit for administration of intravenous antibiotics for prophylaxis for TRUSPBx over 18-month period was performed. Patients had identification of MDR E coli in rectal swab cultures and/or intolerance to available oral agents. Microbiologic data and tolerability of administered antibiotics and outcome after TRUSPBx were tabulated.
  
  
  RESULTS
  Nine patients (median age 74 years) were referred because of antibiotic-resistant E coli from rectal swabs (all fluoroquinolone resistant, 7 MDR). All patients received ertapenem 1 g intravenously 1 day before TRUSPBx and the day of the procedure before TRUSPBx. None of the patients experienced infectious complications immediately after TRUSPBx or several weeks or months later, and no patient was lost to urologic follow-up.
  
  
  CONCLUSIONS
  Increasing worldwide reports of prostatitis, urinary tract infections, and septicemia after TRUSPBx because of MDR E coli suggest rectal screening before procedure may be useful in decreasing complications. Targeted prophylaxis in these instances is necessary. Although carbapenems are used for treatment, they are not routinely used for prophylaxis. We report successful use of ertapenem delivered in a hospital-based OPAT unit for TRUSPBx prophylaxis.
authors.affiliation: The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY.
authors.forename: J
authors.initials: J
authors.lastname: Shakil
authors.affiliation: The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY.
authors.forename: N
authors.initials: N
authors.lastname: Piracha
authors.affiliation: The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY.
authors.forename: N
authors.initials: N
authors.lastname: Prasad
authors.affiliation: The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY.
authors.forename: J
authors.initials: J
authors.lastname: Kopacz
authors.affiliation: Urology Division, Department of Surgery, New York Hospital Queens, Flushing, NY.
authors.forename: A
authors.initials: A
authors.lastname: Tarasuk
authors.affiliation: Urology Division, Department of Surgery, New York Hospital Queens, Flushing, NY.
authors.forename: R
authors.initials: R
authors.lastname: Farrell
authors.affiliation: The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY; Department of Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: C
authors.initials: C
authors.lastname: Urban
authors.affiliation: The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY; Department of Patient Care Services, New York Hospital Queens, Flushing, NY.
authors.forename: N
authors.initials: N
authors.lastname: Mariano
authors.affiliation: Urology Division, Department of Surgery, New York Hospital Queens, Flushing, NY.
authors.forename: G
authors.initials: G
authors.lastname: Wang
authors.affiliation: The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY; Department of Medicine, Weill Cornell Medical College, New York, NY. Electronic address: sxsegalm@nyp.org.
authors.forename: S
authors.initials: S
authors.lastname: Segal-Maurer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D015780:Carbapenems / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D000077727:Ertapenem; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000379:methods*; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D015995:Prevalence; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011472:Prostatitis / Q000188:drug therapy; D012007:Rectum / Q000382:microbiology / Q000473:pathology; D018084:Ultrasonography, Interventional / Q000379:methods*; D047090:beta-Lactams / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D015780:Carbapenems; D047090:beta-Lactams; D000077727:Ertapenem