Prevalence of ciprofloxacin-resistant E. Coli in the intestinal flora of patients undergoing trans-rectal prostate biopsy in Dartford, UK.

Abstract

Aim:

To determine the efficacy of fluoroquinolone prophylaxis in patients undergoing trans-rectal ultrasound scan (TRUS)-guided biopsy of the prostate among the patients in Dartford area, prevalence of ciprofloxacin resistance in the faecal flora and usefulness of a pre-biopsy rectal screen in relation to post biopsy infectious complications.

PATIENTS AND METHODS:

A prospective study was performed from May 2013 to November 2014, collecting the data including rectal swab culture results of all patients (n=100) undergoing TRUS guided Prostate biopsy, with a post-biopsy follow-up period of 2 to 8 months. All patients undergoing TRUS biopsies were given prophylactic oral ciprofloxacin, as per Trust policy (500 mg 12 and one hour pre-biopsy, followed by another 500 mg 12 hour post biopsy.

RESULTS:

Between May 2013 and November 2014, 100 patients were recruited after informed written consent for this study, who required TRUS biopsy to rule out Prostatic malignancy. 94 of these patients underwent TRUS and three Template biopsies, the latter had Gentamicin as prophylaxis; two patients refused, one did not attend for biopsy. Among these, 4 were admitted to hospital for post-biopsy sepsis, but of these two had E. Coli borderline resistance; one each had post-biopsy urinary retention and UTI; only 4 (< 4%) had ciprofloxacin-resistant Escherichia coli confirmed from Rectal swab cultures performed pre-biopsy: four had borderline/ suspected E. Coli. Patients who were admitted to hospital, three of them had positive Blood cultures; all of them were treated with intravenous antibiotics, namely Amikacin, IV Ciprofloxacin, IV Gentamicin, IV Temociliin, oral Doxycycline with Ciprofloxacin for three to six days;--- of them were admitted in to Intensive Care Unit; five patients had post-biopsy MSU with two of them positive for E. Coli.

CONCLUSION:

Ciprofloxacin-resistant E. Coli remains rare in the intestinal flora of Dartford population, therefore, Ciprofloxacin remains adequate prophylaxis against post TRUS biopsy infections. Our current antibiotic policy can be continued without performing pre-TRUS rectal swab cultures. It might be helpful in cases of increasing age, people with history of recent travel to developing country, prior fluoroquinolone use, in an area known to have high fluoroquinolone resistance to guide antibiotic following post-biopsy sepsis and also to validate antibiotic policy of a particular hospital through an audit.

KEYWORDS:

Prostate biopsy; infection; sepsis; fluoroquinolone; rectal swabs; Ciprofloxacin resistance.