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Health See other Health Articles Title: Rectal Microbiota Behind Most Post-Prostate Biopsy Infections NEW YORK (Reuters Health) - Rates of infection following transrectal prostate needle biopsy (TPB) are rising, mainly due to fluoroquinolone-resistant Escherichia coli, and a new study supports the "long-held but untested assumption" that the source of most post-TPB infections is the patient's own rectal microbiota, researchers say. "This is the first study to definitively prove that the bacteria causing prostate biopsy infections are coming from colonized bacteria in the rectum at the time of biopsy (i.e. genetic similarity of the rectal bacteria and the bacteria found in blood are the SAME)," Dr. Michael Liss of the Department of Urology, University of Texas Health Science Center San Antonio told Reuters Health by email. "Measures to prevent rectal colonization with fluoroquinolone-resistant E. coli, and/or to detect such strains in advance of TPB so that antibiotic prophylaxis can be adjusted appropriately, could help reduce the considerable morbidity and costs associated with post-TPB infection," Dr. Liss and colleagues say in their December 16 online paper in Clinical Infectious Diseases. In an observational study, they found that 121 of 764 pre-TPB rectal cultures (15%) yielded a fluoroquinolone-resistant organism (98% E. coli). Post-TPB infection was more common in men colonized with fluoroquinolone-resistant organisms than in non-colonized men (13 of 121, 10.7% vs 8 of 649, 1.2%, p<0.001). In multivariate analysis, hospitalization in the prior year for any cause and the presence of fluoroquinolone-resistant colonizing E. coli were significant risk factors for post-TPB infection (odds ratio 4.5 for both). Of note, say the researchers, E. coli infection (clinical) isolates did not differ from E. coli rectal culture isolates in nine men with paired isolates, suggesting that rectal E. coli are the source of infections and can be identified in advance by rectal culture, they say. "Many urologists are concerned over prostate biopsy infections and have been adding more and stronger antibiotics to prevent infections," Dr. Liss told Reuters Health. "However, this approach may be dangerous because in the long term we may be increasing bacterial resistance and inadvertently making current antibiotics less effective. We propose that performing a rectal culture or some type of identification of the person's colonization status to direct antibiotic prophylaxis is a reasonable approach to provide individualized prophylaxis while abiding antibiotic stewardship," Dr. Liss said. In an editorial, Dr. Deepak Batura from London North West Healthcare NHS Trust in the UK says this single-center study has "once again reiterated the clinical significance of fluoroquinolone resistance as a risk factor for post biopsy infection." In addition to "targeted prophylaxis" guided by pre-biopsy rectal swabs, prophylaxis based on local antibiotic resistant patterns through antibiograms is another potentially useful measure, Dr. Batura says. Povidone iodine rectal washouts or chlorhexidine coated biopsy needles have also been proposed, he notes. Dr. Batura says it's "not unusual for urologists to give a 2-4 week course of ciprofloxacin either for clinical prostatitis or to try and decrease PSA levels and thus eliminate false positive PSAs and unnecessary biopsy. Certainly, this practice has no valid justification but continues to be used by many. This could contribute to fluoroquinolone resistance in these men by the time they have a biopsy." SOURCE: bit.ly/1GUYovT and bit.ly/1AFk6lS Clin Infect Dis 2014.c Editors' Recommendations Tularemia Endomyocardial Biopsy in Cardiovascular Disease Post Comment Private Reply Ignore Thread
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