title: The Value of Rectal Cultures in Treatment of Sepsis Following Post-Transrectal Ultrasound-Guided Prostate Biopsy.
abstract: BACKGROUND
  Cases with sepsis after transrectal ultrasound-guided prostate biopsy (TRUSPB) were documented, with special focus on cultures and susceptibility of isolates. We also evaluated the contribution of concomitant rectal cultures to the treatment of selective cases.
  
  
  METHODS
  Patients with sepsis after TRUSPB were followed prospectively. Manifestations and risk factors for antimicrobial resistance were documented. Results of urine and blood cultures and antimicrobial susceptibility were recorded for all participating patients. In 40 patients, rectal swab cultures were obtained concomitantly.
  
  
  RESULTS
  Ninety-five patients were consecutively studied. Sepsis symptoms started showing up within 48 h after biopsy in 93% of patients. At least one of the cultures was positive in 72 patients. E. coli grew in 70 cases; isolates were highly resistant: 67% displayed multidrug-resistance. Rectal cultures grew E. coli in 38 cases. In patients with positive E. coli in rectum and in at least one additional culture (blood and/or urine), the antibiogram was identical in all cases but one. Eight cases had negative cultures.
  
  
  CONCLUSIONS
  The prevalence of antimicrobial resistance among E. coli isolates from patients with TRUSPB sepsis was alarming. Susceptibilities of rectal E. coli isolates used for deescalation of initial empiric treatment in culture-negative TRUSPB sepsis can contribute to the reduction of broad-spectrum antibiotics exposure.
authors: Infectious Diseases Unit, E. Wolfson Hospital, Holon, Israel.
authors: Tamar
authors: T
authors: Gottesman
authors: Orit
authors: O
authors: Yossepowich
authors: Orna
authors: O
authors: Harari-Schwartz
authors: Alexander
authors: A
authors: Tsivian
authors: Jay
authors: J
authors: Idler
authors: Michael
authors: M
authors: Dan
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001706:Biopsy; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000188:drug therapy; D024841:Fluoroquinolones / Q000627:therapeutic use; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D012007:Rectum / Q000000981:diagnostic imaging / Q000382:microbiology*; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy* / Q000209:etiology; D014463:Ultrasonography; D014572:Urology / Q000379:methods
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D005839:Gentamicins