title: Routine Ertapenem Prophylaxis for Transrectal Ultrasound Guided Prostate Biopsy does Not Select for Carbapenem Resistant Organisms: A Prospective Cohort Study.
abstract: Sepsis after transrectal ultrasound guided prostate biopsy is an increasing problem in this era of rising antibiotic resistance. Although ertapenem prophylaxis has proved effective at our institution to reduce this, it has raised local and regional antimicrobial stewardship concerns. We investigated the possible selective effect of single dose ertapenem prophylaxis on fecal colonization with carbapenem resistant Enterobacteriaceae.
  
  
  
  Patients underwent a rectal swab prior to receiving prebiopsy ertapenem prophylaxis. A second swab was obtained at followup 4 to 6 weeks later. Swabs were screened for carbapenem resistant Enterobacteriaceae using an enhanced CDC (Centers for Disease Control) method. Prebiopsy swabs were also screened for extended spectrum β-lactamase producing and ciprofloxacin resistant Enterobacteriaceae. Patients were monitored for post-biopsy sepsis.
  
  
  
  A total of 326 patients were enrolled in the study. At baseline 6.4% and 9.0% of patients had colonization with extended spectrum β-lactamase producing and ciprofloxacin resistant Enterobacteriaceae, respectively. Carbapenem resistant Enterobacteriaceae were not detected at baseline or followup in any patients. Colonization with nonfermentative organisms with intrinsic ertapenem resistance was detected in 29.4% of patients at baseline and followup (p = 1.0). Three cases (0.9%, 95% CI 0.2-2.8) of probable post-biopsy sepsis were identified during the study period. None was bacteremic or required intensive care unit admission.
  
  
  
  Single dose ertapenem prophylaxis did not appear to have a significant selective effect on fecal colonization with carbapenem resistant Enterobacteriaceae or other ertapenem resistant gram-negative organisms in this outpatient group. It is highly effective prophylaxis for transrectal ultrasound guided prostate biopsy. In the right setting ertapenem may represent a useful prophylactic option to prevent post-transrectal ultrasound guided prostate biopsy sepsis.
authors.affiliation: Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand; Department of Microbiology, Wellington Southern Community Laboratories, Wellington, New Zealand. Electronic address: maxim.bloomfield@ccdhb.org.nz.
authors.forename: Maxim G
authors.initials: MG
authors.lastname: Bloomfield
authors.affiliation: Department of Urology, Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Page
authors.affiliation: Department of Urology, Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Alice G
authors.initials: AG
authors.lastname: McLachlan
authors.affiliation: Department of Urology, Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Rodney C
authors.initials: RC
authors.lastname: Studd
authors.affiliation: Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand; Department of Microbiology, Wellington Southern Community Laboratories, Wellington, New Zealand.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Blackmore
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D000077727:Ertapenem / Q000627:therapeutic use*; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D012007:Rectum / Q000187:drug effects / Q000382:microbiology*; D018084:Ultrasonography, Interventional
chemical_list: D000900:Anti-Bacterial Agents; D000077727:Ertapenem
keywords: Enterobacteriaceae infections; biopsy; drug resistance; ertapenem; microbial; prostate