title: Rapid Identification of Rectal Multidrug-resistant Escherichia coli Before Transrectal Prostate Biopsy.
abstract: OBJECTIVE
  To develop and evaluate a rapid multiplex-quantitative polymerase chain reaction (qPCR) to identify fecal carriers of multidrug-resistant extraintestinal pathogenic Escherichia coli (MDR-ExPEC) clonal groups.
  
  
  METHODS
  Men presenting for transrectal prostate biopsy (TPB) at the San Diego Veterans Affairs Medical Center underwent rectal culture immediately before TPB. Rectal swabs were streaked onto ciprofloxacin-supplemented (4 mg/L) MacConkey agar plates, identified, and susceptibility tested. The same swab was sent to the University of Washington for qPCR test (EST200) targeting 2 major MDR-ExPEC clonal groups--ST131 and ST69--that combined were expected to represent majority of fluoroquinolone (FQ)- and trimethoprim-sulfamethoxazole-resistant E coli. We calculate test characteristics including the area under the receiver operative curve (AUC).
  
  
  RESULTS
  We enrolled 104 men from 11/5/2013 to 6/10/2014. FQ-resistant E coli were cultured from 19.2% (20/104) of rectal swabs, and 26% (27/104) of all swabs were positive for EST200 by PCR. The test characteristics comparing the EST200 to the culture-based detection of FQ resistance were 75%, 86%, 94%, and 56%, respectively. The AUC was 0.84 for the EST200 to detect FQ resistance before TPB.
  
  
  CONCLUSIONS
  Compared to the reference standard rectal culture, EST200 was able to detect majority of FQ-resistant E coli on rectal swabs before prostate biopsy.
authors: Department of Medicine, VA Healthcare System Minneapolis, Minneapolis, MN.
authors: Veronika L
authors: VL
authors: Tchesnokova
authors: Departments of Medicine and Urology, VA Healthcare System San Diego, San Diego, CA.
authors: Linda L
authors: LL
authors: Ottley
authors: Departments of Medicine and Urology, VA Healthcare System San Diego, San Diego, CA; Department of Urology, University of California, San Diego School of Medicine, La Jolla, CA.
authors: Kyoko
authors: K
authors: Sakamoto
authors: Departments of Medicine and Urology, VA Healthcare System San Diego, San Diego, CA; Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA; Department of Pathology, University of California, San Diego School of Medicine, La Jolla, CA.
authors: Joshua
authors: J
authors: Fierer
authors: Department of Urology, University of California, San Diego School of Medicine, La Jolla, CA; Department of Microbiology, University of Washington, Seattle, WA.
authors: Evgeni
authors: E
authors: Sokurenko
authors: Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, TX. Electronic address: mliss008@gmail.com.
authors: Michael A
authors: MA
authors: Liss
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D019540:Area Under Curve; D001707:Biopsy, Needle; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D024841:Fluoroquinolones / Q000494:pharmacology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods; D011300:Preoperative Care; D011467:Prostate / Q000473:pathology*; D012372:ROC Curve; D012007:Rectum / Q000382:microbiology*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination