PURPOSE: Rectal swabs can identify men with fluoroquinolone (FQ)-resistant bacteria and reduce rates of infection after transrectal ultrasound guided prostate biopsy (TRUSB) by targeted antimicrobial prophylaxis.
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We evaluated the rate of FQ resistance in an active surveillance cohort with attention to factors associated with resistance and changes in resistance over time.
MATERIALS AND METHODS: We evaluated 416 men with prostate cancer on active surveillance that underwent rectal swabs for assessment of rates of FQ resistance, compared to men undergoing diagnostic TRUSB. Chi-square and Student t-tests were used for a comparison of categorical and continuous variables, respectively. Poisson regression analysis was used in multivariable analysis.
RESULTS: On initial swab, FQ resistance was found in 95 of 416 (22.8%) men on active surveillance, compared to 54 of 221 (24.4%) men in the diagnostic TRUSB cohort, p=0.675. Diabetes was found in 4.0% of the FQ sensitive group vs. 14.7 % in the resistant group (p < 0.001). Biopsy history was not associated with resistance. Of those who had resistant first swabs, 62.9% had resistant second swabs, and of those with two resistant swabs 88.9% were resistant on their third swab. Of those with sensitive first swabs, 10.6% developed resistance on the second swab, and of those with two sensitive swabs 10.6% had resistant third swabs.
CONCLUSION: One in four men presenting for surveillance and diagnostic TRUSB have rectal flora resistant to FQ. Resistance was significantly associated with diabetes but not the number of prior biopsies. Men with FQ resistant flora tend to remain resistant over time.
Cohen JE, Landis P, Trock BJ, Patel HD, Ball MW, Auwaerter PG, Schaeffer E, Carter B. Are you the author?
The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine.
Reference: J Urol. 2014 Aug 8. pii: S0022-5347(14)04178-0.