Escherichia coli bloodstream infection after transrectal ultrasound-guided prostate biopsy: Implications of fluoroquinolone-resistant sequence type 131 as a major causative pathogen

Williamson, Deborah A., Roberts, Sally A., Paterson, David L., Sidjabat, Hanna, Silvey, Anna, Masters, Jonathan, Rice, Michael and Freeman, Joshua T. (2012) Escherichia coli bloodstream infection after transrectal ultrasound-guided prostate biopsy: Implications of fluoroquinolone-resistant sequence type 131 as a major causative pathogen. Clinical Infectious Diseases, 54 10: 1406-1412.


Author Williamson, Deborah A.
Roberts, Sally A.
Paterson, David L.
Sidjabat, Hanna
Silvey, Anna
Masters, Jonathan
Rice, Michael
Freeman, Joshua T.
Title Escherichia coli bloodstream infection after transrectal ultrasound-guided prostate biopsy: Implications of fluoroquinolone-resistant sequence type 131 as a major causative pathogen
Journal name Clinical Infectious Diseases  (ERA 2012 Listed)    (ERA 2010 Rank A*)   Check publisher's open access policy
Publication date 2012-05
Sub-type Article
DOI 10.1093/cid/cis194
Volume number 54
Issue number 10
ISSN 1058-4838;1537-6591
Start page 1406
End page 1412
Total pages 7
Place of publication Cary, NC, United States
Publisher Oxford University Press
Collection year 2013
Language eng
Formatted abstract Background.
Transrectal ultrasound-guided (TRUS) prostate biopsy is a commonly performed procedure, and fluoroquinolones are themost frequently given prophylactic antimicrobials. In the context of increasing fluoroquinolone resistance, and the international emergence of fluoroquinolone-resistant sequence type 131 (ST131) Escherichia coli, we describe a large series of E. coli bacteremia after TRUS biopsy.

Methods.
All male patients admitted with community-onset (CO) E. coli bacteremia from January 2006 through December 2010 were included. Patient characteristics, treatment outcomes, and rates of antimicrobial resistance were compared between patients with TRUS biopsy-related bacteremia and other male patients with CO E. coli bacteremia. Molecular typing was performed on E. coli isolates to determine phylogenetic group.

Results.
A total of 258 male patients were admitted with CO E. coli bacteremia. Of these, 47 patients (18%) were admitted after TRUS biopsy. Patients who had undergone TRUS biopsy were twice as likely to require intensive care admission (25% vs 12%) and had significantly higher rates of resistance to gentamicin (43%), trimethoprimsulphamethoxazole (60%), and ciprofloxacin (62%) as well as all 3 agents in combination (19%). Thirty-six percent of post-TRUS biopsy patients did not receive active empirical antibiotic therapy. The ST131 clone accounted for 41% of all E. coli isolates after TRUS biopsy.

Conclusions.
E. coli bacteremia can be a life-threatening complication of TRUS biopsy. Infecting strains are frequently multidrug-resistant and resistant to common empirical antibiotic agents. E. coli ST131 is an important cause of sepsis after TRUS biopsy. Further studies should evaluate colonization with fluoroquinolone-resistant E. coli as a risk factor for postbiopsy sepsis.
Keyword Clone St131
Needle-Biopsy
Prophylaxis
Bacteremia
Urosepsis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes First published online: 14 March 2012.

 
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