Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Urology. 2011 Dec;78(6):1235-9. doi: 10.1016/j.urology.2011.07.1392. Epub 2011 Sep 10.
To study the prevalence of fluoroquinolone-resistant Escherichia coli before transrectal ultrasound (TRUS)-guided prostate biopsy and prospectively analyze the rates of infective complications after biopsy in patients receiving fluoroquinolone prophylaxis. E. coli is the pathogen most commonly associated with infections after TRUS-guided prostate biopsy, and the prevalence of fluoroquinolone-resistant E. coli is increasing.
We analyzed the prospective data from 100 patients who underwent TRUS-guided prostate biopsy from April to December 2010. A stool culture was obtained 1 month before biopsy. Patients received 500 mg levofloxacin orally once daily for 3 days, beginning 2 hours before biopsy. All biopsies were performed as outpatient procedures.
Of the 100 patients, 13 (13%) had a stool culture positive for fluoroquinolone-resistant E. coli. In 4 (31%) of these 13 patients, acute bacterial prostatitis was detected after TRUS-guided prostate biopsy. Of the 87 patients whose stool culture was negative for fluoroquinolone-resistant E. coli, none had acute bacterial prostatitis. All 13 infected patients were treated with carbapenems immediately after diagnosis of prostatitis and made a complete recovery.
Prophylactic fluoroquinolone is still effective in preventing acute bacterial prostatitis after TRUS-guided prostate biopsy. The incidence is relatively low in patients with fluoroquinolone-sensitive E. coli. However, the prevalence of fluoroquinolone-resistant E. coli is about 13% in this population. Stool cultures for the detection of fluoroquinolone-resistant E. coli might be obtained before TRUS-guided prostate biopsy.
研究经直肠超声（TRUS）引导前列腺活检前氟喹诺酮耐药大肠埃希菌的流行情况，并前瞻性分析接受氟喹诺酮预防的患者在活检后感染性并发症的发生率。大肠埃希菌是 TRUS 引导前列腺活检后感染最常见的病原体，氟喹诺酮耐药大肠埃希菌的流行率正在上升。
我们分析了 2010 年 4 月至 12 月期间 100 例接受 TRUS 引导前列腺活检的患者的前瞻性数据。在活检前 1 个月采集粪便培养。患者接受 500mg 左氧氟沙星口服，每天 1 次，共 3 天，在活检前 2 小时开始。所有活检均作为门诊手术进行。
在 100 例患者中，13 例（13%）的粪便培养出氟喹诺酮耐药大肠埃希菌。在这 13 例患者中，4 例（31%）在 TRUS 引导前列腺活检后检测到急性细菌性前列腺炎。在 87 例粪便培养氟喹诺酮耐药大肠埃希菌阴性的患者中，无一例发生急性细菌性前列腺炎。所有 13 例感染患者在诊断为前列腺炎后立即使用碳青霉烯类药物治疗，并完全康复。
预防性氟喹诺酮类药物仍然有效预防 TRUS 引导前列腺活检后急性细菌性前列腺炎。在氟喹诺酮敏感大肠埃希菌患者中，其发病率相对较低。然而，在该人群中，氟喹诺酮耐药大肠埃希菌的流行率约为 13%。在 TRUS 引导前列腺活检前可能需要进行粪便培养以检测氟喹诺酮耐药大肠埃希菌。
