ORLANDO, FL USA (UroToday.com) - At the infection/inflammation poster session, Dr. Michael Liss discussed a timely issue of fecal carriage of fluoroquinolone resistance and prostate biopsy infection. Prostate biopsy infection has become a debated topic at the AUA this year even being an upcoming focus of the chief resident debate. The purpose of the current study was to determine if rectal culture can identify men at high risk of post-TRPB infection.
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While many studies have advocated for the use of rectal culture to tailor antibiotic therapy, few studies have addressed if the rectal swab as a prognostic indicator of infection in the first place. In this study, Dr. Liss and colleagues developed a retrospective international collaboration representing over 2 600 men undergoing prostate biopsy. The primary outcome was any post-TRPB infection and the secondary outcome was 30-day post-TRPB hospital admission. Statistical analysis was performed to obtain an odds ratio of infection and admission if the rectal culture was positive or negative for fluoroquinolone resistant fecal carriage (e.g., colonization of the rectum). The prevalence of FQR was 20.5% (549/2673) and positive rectal cultures were associated with post-biopsy infection (6.6% vs 1.6%; p < 0.001) and hospitalization (4.4% vs 0.9%; p < 0.001). The most common FQR bacteria isolates were Escherichia coli (83.7%).
Dr. Liss did acknowledge some key limitations of the study which include the retrospective study design and non-standardized culture methods. Overall a positive result for fluoroquinolone resistant organisms on rectal culture does identify men at higher risk for infection and subsequent hospitalization from prostate biopsy. Essentially men who were culture positive for resistance and who only receive a fluoroquinolone for prophylaxis had a 5 times higher hospital admission rate. This study highlights the ability of the rectal culture to identify high-risk men with rectal culture, however it does not comment on tailored or ”targeted” prophylaxis as most cultures in the study were performed at the time of the prostate biopsy. Future studies are needed to provide information regarding the targeted approach using rectal culture to change antibiotic prophylaxis.
Presented by Michael Liss at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Vancouver, BC Canada
Written by Zhamshid Okhunov, MD, University of California (Irvine), and medical writer for UroToday.comy