title: Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy.
abstract: OBJECTIVE
  Infection after transrectal prostate biopsy has become an increasing concern due to fluoroquinolone resistant bacteria. We determined whether colonization identified by rectal culture can identify men at high risk for post-transrectal prostate biopsy infection.
  
  
  METHODS
  Six institutions provided retrospective data through a standardized, web based data entry form on patients undergoing transrectal prostate biopsy who had rectal culture performed. The primary outcome was any post-transrectal prostate biopsy infection and the secondary outcome was hospital admission 30 days after transrectal prostate biopsy. We used chi-square and logistic regression statistical analysis.
  
  
  RESULTS
  A total of 2,673 men underwent rectal culture before transrectal prostate biopsy from January 1, 2007 to September 12, 2013. The prevalence of fluoroquinolone resistance was 20.5% (549 of 2,673). Fluoroquinolone resistant positive rectal cultures were associated with post-biopsy infection (6.6% vs 1.6%, p <0.001) and hospitalization (4.4% vs 0.9%, p <0.001). Fluoroquinolone resistant positive rectal culture increased the risk of infection (OR 3.98, 95% CI 2.37-6.71, p <0.001) and subsequent hospital admission (OR 4.77, 95% CI 2.50-9.10, p <0.001). If men only received fluoroquinolone prophylaxis, the infection and hospitalization proportion increased to 8.2% (28 of 343) and 6.1% (21 of 343), with OR 4.77 (95% CI 2.50-9.10, p <0.001) and 5.67 (95% CI 3.00-10.90, p <0.001), respectively. The most common fluoroquinolone resistant bacteria isolates were Escherichia coli (83.7%). Limitations include the retrospective study design, nonstandardized culture and interpretation of resistance methods.
  
  
  CONCLUSIONS
  Colonization of fluoroquinolone resistant organisms in the rectum identifies men at high risk for infection and subsequent hospitalization from prostate biopsy, especially in those with fluoroquinolone prophylaxis only.
authors.affiliation: University of California-San Diego, La Jolla, California. Electronic address: mliss008@gmail.com.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Taylor
authors.affiliation: Department of Urology & Microbiology, Ealing Hospital NHS Trust and Northwest London Hospitals NHS Trust, London, United Kingdom.
authors.forename: Deepak
authors.initials: D
authors.lastname: Batura
authors.affiliation: University Hospital Leuven, Gasthuisberg, Leuven, Belgium.
authors.forename: Deborah
authors.initials: D
authors.lastname: Steensels
authors.affiliation: Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Methee
authors.initials: M
authors.lastname: Chayakulkeeree
authors.affiliation: University Hospital Leuven, Gasthuisberg, Leuven, Belgium.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Soenens
authors.affiliation: Department of Urology & Microbiology, Ealing Hospital NHS Trust and Northwest London Hospitals NHS Trust, London, United Kingdom.
authors.forename: G Gopal
authors.initials: GG
authors.lastname: Rao
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Atreya
authors.initials: A
authors.lastname: Dash
authors.affiliation: University of California-San Diego, La Jolla, California.
authors.forename: Samuel
authors.initials: S
authors.lastname: Park
authors.affiliation: University of California-San Diego, La Jolla, California.
authors.forename: Nishant
authors.initials: N
authors.lastname: Patel
authors.affiliation: University of California-San Diego, La Jolla, California.
authors.forename: Jason
authors.initials: J
authors.lastname: Woo
authors.affiliation: University of California-San Diego, La Jolla, California.
authors.forename: Michelle
authors.initials: M
authors.lastname: McDonald
authors.affiliation: University of California-San Diego, La Jolla, California.
authors.forename: Unwanaobong
authors.initials: U
authors.lastname: Nseyo
authors.affiliation: University of California-San Diego, La Jolla, California.
authors.forename: Pooya
authors.initials: P
authors.lastname: Banapour
authors.affiliation: University of California-San Diego, La Jolla, California.
authors.forename: Stephen
authors.initials: S
authors.lastname: Unterberg
authors.affiliation: University of California-Irvine, Orange, California; VA Healthcare Long Beach, Long Beach, California.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Ahlering
authors.affiliation: University Hospital Leuven, Gasthuisberg, Leuven, Belgium.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Van Poppel
authors.affiliation: University of California-San Diego, La Jolla, California; VA Healthcare San Diego, La Jolla, California.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: University of California-San Diego, La Jolla, California; VA Healthcare San Diego, La Jolla, California.
authors.forename: Joshua
authors.initials: J
authors.lastname: Fierer
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Black
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001424:Bacterial Infections / Q000453:epidemiology; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology*; D011467:Prostate / Q000473:pathology*; D012007:Rectum / Q000382:microbiology*; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: biopsy; drug resistance; infection; microbial; prostate