Prevalence of antibiotic resistance in fecal flora before transrectal ultrasound-guided prostate biopsy and the clinical impact of targeted antibiotic prophylaxis.

OBJECTIVES: In this study, we aimed to evaluate ciprofloxacin resistance and the presence of extended-spectrum beta-lactamase producing organisms (ESBLs) in the population of patients with indication to undergo prostate biopsy. Our additional aim was to compare the targeted antibiotic prophylaxis and sepsis rates after transrectal ultrasound guided prostate biopsy in patients who received routine ciprofloxacin prophylaxis and to evaluate the predictive factors of antibiotic resistance.

METHODS: Between September 2012 and January 2014, 300 patients were randomized to two groups. The first group (Group 1, n=156) received routine ciprofloxacin prophylaxis and the second group (Group 2, n=144) received a targeted prophylactic antibiotic regime that was adequate for rectal swab culture results. Rectal swab cultures were collected two weeks before the procedure. After the procedure, patients were followed for one month and told to return to the hospital if they developed a fever (>38°C), shivering, dysuria or fatigue.

RESULTS: In Group 1, four patients (2.6%) returned to our clinic with signs of sepsis; no patient in Group 2 returned to our clinic (p= 0.124). When the rectal swab culture results of Group 2 were evaluated, there were ESBLs in 18 patients (12.5%), quinolone resistance in 26 patients (18%), and both ESBLs and quinolone resistance in 15 patients (10.4%). There were no statistically significant differences between antibiotic resistance and urologic operations, urinary tract infections, prior catheterization history, the presence of a catheter during prostate biopsy and antibiotic usage history due to a high PSA level.

CONCLUSION: In our study, the rates of ESBL presence and ciprofloxacin resistance in rectal flora were not negligible. However, by obtaining rectal swab cultures prior to performing transrectal prostate biopsies and using targeted prophylaxis before prostate biopsy, the sepsis rates were reduced; however, this effect was statistically insignificant. Additional studies with a larger patient population could help to evaluate the targeted prophylaxis procedure.