Fluoroquinolone-resistant acute prostatitis requiring hospitalization after transrectal prostate biopsy: effect of previous fluoroquinolone use as prophylaxis or long-term treatment

• Published in: International urology and nephrology 2012-02, Vol.44 (1), p.19-27
• Main Authors: Ekici, Sinan, Cengiz, Melahat, Turan, Güven, Alış, Esra Ergün
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents - therapeutic use; Antibiotic Prophylaxis - adverse effects; Biopsy - adverse effects; Carbapenems - therapeutic use; Ceftriaxone - therapeutic use; Ciprofloxacin - therapeutic use; Drug Resistance, Multiple, Bacterial; Enterococcus; Escherichia coli; Escherichia coli Infections - drug therapy; Fluoroquinolones - therapeutic use; Hospitalization; Humans; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Prostate - pathology; Prostate-Specific Antigen - blood; Prostatitis - blood; Prostatitis - drug therapy; Prostatitis - microbiology; Retrospective Studies; Urology; Urology – Original Paper; Vancomycin - therapeutic use
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-011-9980-3

Objectives This study aims to scrutinize the hospitalized patients with the diagnosis of acute prostatitis after transrectal ultrasound-guided biopsy of the prostate (TRUSBP) focusing their history of previous antibiotic use, clinical pictures, microbiologic features, and resistance patterns of the isolates. Patients and methods A retrospective evaluation of the records between 2005 and 2010 revealed 13 patients. All patients received ciprofloxacin 500 mg twice a day starting from the day before TRUSBP for 5 days. Results Positive 13 urine and 7 blood samples (Escherichia coli in 12 patients, Enterococcus species in one) were evaluated for resistance patterns. All were resistant to fluoroquinolones. Extended spectrum beta-lactamase producing E. coli isolated in 4 patients were treated with carbapenems. Empirical ceftriaxone was shifted to carbapenem (4 patients), vancomycin (1 patient). Empirical carbapenem was maintained in 5 patients. Seven patients with elevated PSA received fluoroquinolones for 4 weeks before TRUSBP on the assumption that they had subclinical infectious prostatitis. Previous exposure to fluoroquinolones did not lead to important differences in respect to the studied parameters. Conclusions The prompt initiation of effective treatment is essential to decrease morbidity and mortality. Empirical treatment would be a second or third generation cephalosporins, or carbapenems according to clinical severity of patients.