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Predictors of fluoroquinolone-resistant bacteria in the rectal vault of men undergoing prostate biopsy

Prostate Cancer and Prostatic Diseases volume 22, pages 268–275 (2019)Cite this article

Subjects

A Correction to this article was published on 31 January 2019

This article has been updated

Abstract

Importance

Fluoroquinolone (FQ)-resistant rectal vault flora is associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-PNB).

Objective

To determine the patient factors that predict FQ-resistant rectal cultures in men who are undergoing transrectal ultrasound-guided prostate needle biopsy.

Methods

An IRB approved retrospective review of 6183 consecutive men who had undergone a rectal swab culture in preparation for TRUS-PNB between January 2013 and December 2014 was performed. Multivariable logistic regression was used to determine the clinical and demographic factors associated with FQ-resistant Enterobacteriaceae in the rectal vault.

Results

Of the 6179 rectal swabs analyzed, 4842 (78%) were FQ-sensitive, and 1337 (22%) were FQ-resistant. On univariable analysis, increasing age, prior TRUS-PNB, higher number of biopsy cores obtained, diabetes mellitus, antimicrobial use within the past 6 months and non-Caucasian race were predictors of FQ-resistance (all p < 0.05). Men with FQ-resistant cultures were more likely to have benign pathology on TRUS-PNB (p = 0.004). On multivariable analysis, increasing patient age (OR = 1.01/year [1.00–1.02]), use of antimicrobials in the last 6 months (OR = 2.85[2.18–3.72]), African American (OR = 1.99 [1.66–2.37]), Asian (OR = 3.39 [2.63–4.37]), and Hispanic (OR = 2.10 [1.72–2.55]) races were independently associated with FQ-resistant rectal cultures. The overall infectious rate was 1.1% (56/5214) and the sepsis rate was 0.46% (24/5214). The infection rate in the FQ-resistant group was 3.9% (43/1107) compared to FQ-sensitive group 0.3% (13/4107), p < 0.001.

Conclusion

In this cohort, increasing age, recent antimicrobial-use, and non-Caucasian race were independent predictors of FQ-resistance in the rectal vault. As FQ-resistance is associated with infectious complications from transrectal ultrasound-guided prostate needle biopsy, understanding risk factors may assist infection control efforts.

Key points

  • Question: What are the factors that predict fluoroquinolone (FQ)-resistant rectal cultures in men undergoing transrectal ultrasound-guided prostate needle biopsy?

  • Findings: Increasing age, recent antimicrobial-use, African American, Asian, and Hispanic race were independent predictors of FQ resistance in the rectal vault.

  • Meaning: Older man, antimicrobial usage within 6 months, African American, Asian and Hispanic race were  associated with men with FQ-resistance rectal flora and may benefit from alternative prophylaxis and monitoring strategies.

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Change history

  • 31 January 2019

    The original version of this article contained an error in the name of author Alfredo Mena Lora. This has now been corrected.

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Author information

Authors and Affiliations

  1. Division of Urology, Rush University Medical Center, Chicago, IL, USA

    Wei Phin Tan, Dimitri Papagiannopoulos, Kalyan C Latchamsetty, Nathaniel Wilson, Nicholas O’Block & Christopher L Coogan

  2. Uropartners LLC, Chicago, IL, USA

    Lester Raff & Christopher L Coogan

  3. Division of Infectious Diseases, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA

    Alfredo Mena Lora

  4. Department of Urology, University of Illinois Chicago, Chicago, IL, USA

    Michael R Abern

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  1. Wei Phin Tan
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Correspondence to Wei Phin Tan.

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Tan, W., Papagiannopoulos, D., Latchamsetty, K.C. et al. Predictors of fluoroquinolone-resistant bacteria in the rectal vault of men undergoing prostate biopsy. Prostate Cancer Prostatic Dis 22, 268–275 (2019). https://doi.org/10.1038/s41391-018-0092-3

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