University of California-San Diego, La Jolla, California.
University of British Columbia, Vancouver, Canada.
J Urol. 2014 Dec;192(6):1673-8. doi: 10.1016/j.juro.2014.06.005. Epub 2014 Jun 10.
Infection after transrectal prostate biopsy has become an increasing concern due to fluoroquinolone resistant bacteria. We determined whether colonization identified by rectal culture can identify men at high risk for post-transrectal prostate biopsy infection.
Six institutions provided retrospective data through a standardized, web based data entry form on patients undergoing transrectal prostate biopsy who had rectal culture performed. The primary outcome was any post-transrectal prostate biopsy infection and the secondary outcome was hospital admission 30 days after transrectal prostate biopsy. We used chi-square and logistic regression statistical analysis.
A total of 2,673 men underwent rectal culture before transrectal prostate biopsy from January 1, 2007 to September 12, 2013. The prevalence of fluoroquinolone resistance was 20.5% (549 of 2,673). Fluoroquinolone resistant positive rectal cultures were associated with post-biopsy infection (6.6% vs 1.6%, p <0.001) and hospitalization (4.4% vs 0.9%, p <0.001). Fluoroquinolone resistant positive rectal culture increased the risk of infection (OR 3.98, 95% CI 2.37-6.71, p <0.001) and subsequent hospital admission (OR 4.77, 95% CI 2.50-9.10, p <0.001). If men only received fluoroquinolone prophylaxis, the infection and hospitalization proportion increased to 8.2% (28 of 343) and 6.1% (21 of 343), with OR 4.77 (95% CI 2.50-9.10, p <0.001) and 5.67 (95% CI 3.00-10.90, p <0.001), respectively. The most common fluoroquinolone resistant bacteria isolates were Escherichia coli (83.7%). Limitations include the retrospective study design, nonstandardized culture and interpretation of resistance methods.
Colonization of fluoroquinolone resistant organisms in the rectum identifies men at high risk for infection and subsequent hospitalization from prostate biopsy, especially in those with fluoroquinolone prophylaxis only.
由于氟喹诺酮类耐药菌的出现，经直肠前列腺活检后的感染已成为一个日益关注的问题。我们确定直肠培养物鉴定的定植是否可以识别经直肠前列腺活检后发生感染的高危男性。
六家机构通过基于网络的标准化数据输入表提供了 2007 年 1 月 1 日至 2013 年 9 月 12 日期间接受经直肠前列腺活检的患者的回顾性数据，这些患者接受了直肠培养。主要结局是任何经直肠前列腺活检后的感染，次要结局是经直肠前列腺活检后 30 天的住院治疗。我们使用卡方检验和逻辑回归统计分析。
共有 2673 名男性在 2007 年 1 月 1 日至 2013 年 9 月 12 日期间接受了直肠培养，氟喹诺酮类耐药的发生率为 20.5%（2673 例中的 549 例）。氟喹诺酮类耐药阳性直肠培养与活检后感染（6.6% vs 1.6%，p<0.001）和住院（4.4% vs 0.9%，p<0.001）相关。氟喹诺酮类耐药阳性直肠培养增加了感染的风险（OR 3.98，95%CI 2.37-6.71，p<0.001）和随后的住院（OR 4.77，95%CI 2.50-9.10，p<0.001）。如果男性仅接受氟喹诺酮类预防治疗，感染和住院比例增加至 8.2%（28 例/343 例）和 6.1%（21 例/343 例），OR 分别为 4.77（95%CI 2.50-9.10，p<0.001）和 5.67（95%CI 3.00-10.90，p<0.001）。最常见的氟喹诺酮类耐药菌分离株是大肠杆菌（83.7%）。局限性包括回顾性研究设计、直肠培养和耐药方法的非标准化。
直肠中氟喹诺酮类耐药菌的定植可识别经直肠前列腺活检后发生感染和随后住院治疗的高危男性，尤其是在仅接受氟喹诺酮类预防治疗的男性中。
