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Bacteraemia after transrectal ultrasound guided prostate biopsy in the era of multidrug resistance: impact of a new preventive protocol

Abstract number: R2426

Horcajada J.P., Busto M., Grau S., Salvadó M., Terradas R., Sorlí L., González A., Knobel H.

Objectives: Although the incidence of bacteraemia after transrectal ultrasound guided prostate biopsy (TRUSGPB) is low under antibiotic prophylaxis (0.5%), emergence of resistant microorganisms is becoming worrisome. We had to implement a new preventive protocol because a high incidence of bacteraemia was observed under the old preventive protocol (OLDPP). We assessed the incidence of bacteraemia and characteristics of isolated microorganisms, before and after the setting up of a new preventive protocol (NEWPP) in patients undergoing TRUSGPB.

Methods: this study was performed at an University hospital in Barcelona, Spain, in which a mean of 200 TRUSGPB are performed annually. Description of preventive protocols, analysis of the incidence of bacteraemia before and after setting up a NEWPP, and description of isolated microorganisms and antibiotic resistance patterns were done. During the 2nd period patients were prospectively followed after the procedure.

Results: OLDPP (Jan 2006-Feb 2007): amoxicillin/clavulanate 500 mg tid the day before, the day of the procedure and one day after; NEWPP (Mar 2007-Nov 2007): cefoxitin 2 g one hour before the procedure and ciprofloxacin 750 mg po bid the day before, the day of the procedure and 3 days after the procedure; a dipstick urinalysis (i.e., leukocyte esterase test and nitrite test) was performed before the procedure, and patients with positive results were not biopsed. Incidence of bacteraemia after TRUSGPB with OLDPP vs NEWPP: 9/204 (4.4%) vs 0/105 (0%), (p = 0.022); Isolated microorganisms in blood cultures with OLDPP: Escherichia coli 6 (66.6%), Klebsiella pneumoniae 2 (22.2%) and Morganella morganii 1 (11.1%). Enterobacter cloacae was also isolated in one case; five (55%) of the isolates were quinolone resistant and 4 (44.4%) produced extended spectrum betalactamases and were also resistant (CMI > 16/8) or intermediate to amoxicillin-clavulanate (CMI = 16/8). With the NEWPP 2 (1.9%) cases of low-grade fever without bacteraemia were recorded. 29 (27%) cases were not biopsed because of positive dipstick urinalysis.

Conclusions: Before TRUSGBP, excluding patients with positive dipstick urinalysis is an advisable practice. Antibiotic prophylaxis should take into account local resistance patterns. Cefoxitin could be used as prophylaxis in centres with high prevalence of extended-spectrum betalactamase enterobacteriaceae

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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