title: Fluoroquinolone-ResistantEscherichia coliInfections After Transrectal Biopsy of the Prostate in the Veterans Affairs Healthcare System.
abstract: BACKGROUND
  Recent reports suggest that infections due to fluoroquinolone-resistantEscherichia coli (E. coli)are an increasingly common complication of transrectal biopsy of the prostate (TBP) in the United States. A better understanding of the magnitude and scope of these infections is needed to guide prevention efforts. Our objective is to determine whether the incidence of infections due to fluoroquinolone-resistantE. coliafter TBP has increased nationwide in the Veterans Affairs Health Care System and to identify risk factors for infection.
  
  
  METHODS
  We performed a retrospective, observational cohort study and a nested case-control study within the US Deparment of Veterans Affairs Healthcare System. The primary outcomes were the incidence of urinary tract infection (UTI) and bacteremia withE. coliand with fluoroquinolone- resistantE. colistrains within 30 days after TBP. Secondary endpoints focused on the correlation between fluoroquinolone-resistance in all urinaryE. coliisolates and post-TBP infection and risk factors for infection due to fluoroquinolone-resistantE. coliinfection.
  
  
  RESULTS
  245 618 patients undergoing 302 168 TBP procedures from 2000 through 2013 were included in the cohort study, and 59 469 patients undergoing TBP from 2011 through 2013 were included in the nested case-control study. Between 2000 and 2013, there was a 5-fold increase in the incidence ofE. coliUTI (0.18%-0.93%) and a 4-fold increase in the incidence ofE. colibacteremia (0.04%-0.18%) after TBP that was attributable to an increase in the incidence of fluoroquinolone- resistantE. coliUTI (0.03%-0.75%) and bacteremia (0.01%-0.14%). The increasing incidence of fluoroquinolone-resistantE. coliinfections after TBP occurred in parallel with increasing rates of fluoroquinolone-resistance in all urinaryE. coliisolates. By multivariable logistic regression analysis, independent risk factors for fluoroquinolone-resistantE. coliUTI after TBP included diabetes mellitus, fluoroquinolone exposure, prior hospitalization, and prior cultures with fluoroquinolone-resistant gram-negative bacilli.
  
  
  CONCLUSIONS
  In the Veterans Affairs Healthcare System, the incidence ofE. coliinfection after TBP has increased significantly since 2000 due to a dramatic rise in infections with fluoroquinolone- resistantE. coli.
authors: Infectious Diseases Division, University Hospitals, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
authors: Elie A
authors: EA
authors: Saade
authors: Infectious Diseases Division, University Hospitals, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
authors: Nuntra
authors: N
authors: Suwantarat
authors: Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.
authors: Trina F
authors: TF
authors: Zabarsky
authors: Geriatric Research Education and Clinical Center, Cleveland VA Medical Center, Cleveland, OH.
authors: Brigid
authors: B
authors: Wilson
authors: Case Western Reserve University School of Medicine, Cleveland, OH; Geriatric Research Education and Clinical Center, Cleveland VA Medical Center, Cleveland, OH.
authors: Curtis J
authors: CJ
authors: Donskey
keywords: Escherichia coli infections; United States Department of Veterans Affairs; bacteremia; case-control studies; cohort studies; early detection of cancer; microbial drug resistance; postoperative complications; prostate; retrospective studies; urinary tract infections