Protocolo Profilaxis Antibiotica Biopsia De Prostata

Int Urol Nephrol (2012) 44:19–27
DOI 10.1007/s11255-011-9980-3

UROLOGY – ORIGINAL PAPER

Fluoroquinolone-resistant acute prostatitis requiring
hospitalization after transrectal prostate biopsy: effect
of previous fluoroquinolone use as prophylaxis or long-term
treatment
¨
Sinan Ekici • Melahat Cengiz • Guven Turan
¨
Esra Ergun Alıs
¸

•

Received: 15 February 2011 / Accepted: 19April 2011 / Published online: 6 May 2011
Ó Springer Science+Business Media, B.V. 2011

Abstract
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 ofthe 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 resistantto fluoroquinolones. Extended spectrum beta-lactamase producing E. coli isolated in 4

S. Ekici (&) Á G. Turan
Department of Urology, Maltepe University School
of Medicine, Feyzullah Caddesi, No: 39,
34843 Istanbul, Turkey
e-mail: ekicimiami@yahoo.com
G. Turan
e-mail: drguventuran@yahoo.com
M. Cengiz Á E. E. Alıs
¸
Department of Infectious Diseases, Maltepe University
School ofMedicine, Istanbul, Turkey
e-mail: Melahat_cengiz@yahoo.com
E. E. Alıs
¸
e-mail: ergunesra03@yahoo.com

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 hadsubclinical
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.Keywords Extended spectrum beta lactamases Á
Prophylaxis Á Antibiotic resistance Á
Acute prostatitis Á Prostate biopsy

Introduction
Transrectal ultrasound-guided biopsy of the prostate
(TRUSBP) is generally accepted as the standard
procedure to detect prostate cancer. Although it is a
safe procedure with low morbidity, it carries the risk of
serious and potentially life-threateninginfections.
Infectious complications vary from asymptomatic
bacteriuria, bacteraemia and fever to sepsis and
septic shock. The main causative microorganisms are
Escherichia coli, Klebsiella pneumonia, Pseudomonas

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aeruginosa, and Enterococcus spp [1, 2]. Several
randomized control trials have confirmed that prophylactic antibiotic use decreases the rate of infections
after TRUSBP [1,2]. Their overall safety and ease of
use presented fluoroquinolones as the antibiotic of
choice for prophylaxis of TRUSBP and to treat
prostatitis [1–3]. However, recently a worldwide,
inexorable rise in fluoroquinolone resistance has
appeared [4]. The widespread and irrational use of
fluoroquinolones was accused. Although it is controversial, one of the clinical applications in daily practiceis administration of fluoroquinolones for long-term
before TRUSBP for a patient with a newly increased
prostate specific antigen (PSA) on the presumption that
the patient has subclinical infectious prostatitis [3].
This kind of use of fluoroquinolones might be one of
the causes in development of resistance to fluoroquinolones, and even further extended spectrum betalactamase (ESBL) production....