Tukenmez Tigen Elif, Tandogdu Zafer, Ergonul Onder, Altinkanat Gulsen, Gunaydin Bilal, Ozgen Mahir, Sariguzel Nevin, Erturk Sengel Buket, Odabasi Zekaver, Cek Mete, Tokuc Resit, Turkeri Levent, Mulazimoglu Lutfiye, Korten Volkan
Department of Infectious Diseases, School of Medicine, Marmara University, Istanbul, Turkey.
Department of Urology, Taksim Training and Research Hospital, Istanbul, Turkey.
Urology. 2014 Nov;84(5):1008-15. doi: 10.1016/j.urology.2014.04.060. Epub 2014 Sep 18.
To determine the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (PE) fecal carriage in patients that undergo transrectal ultrasonography-guided biopsy (TRUSbx) and its relationship with post-biopsy infections.
A prospective clinical study in 4 different tertiary hospitals between 2008 and 2010 was conducted. Four hundred men with sterile urine who were to undergo a TRUSbx because of the suspicion of prostate cancer were included and followed for 14 days after biopsy. Rectal swab culture specimens were acquired immediately before the procedure. Demographic data, prophylaxis choice, quinolone or any other antibiotic consumption within the past 2 months, history of prostatitis, repeat biopsy, intensive care unit admission, hospitalization, urethral catheterization, diabetes mellitus (DM), and steroid usage were recorded.
ESBL carriage was detected in 19% of patients and quinolone use within the last 2 months; other antibiotic use within the last 2 months and DM were found to be significantly associated (P <.05). Symptomatic urinary tract infection (UTI) on the third day after biopsy was seen in 9% of patients and was associated with fluoroquinolone (FQ) consumption before biopsy. Although ESBL-PE carriage was associated with post-biopsy UTI symptoms, it was not found to be associated with post-biopsy symptomatic UTI. Urosepsis was seen in 2 patients (0.5%) after biopsy, and both the patients were ESBL-PE carriers.
The presence of ESBL-PE was associated with DM and FQ consumption before biopsy. ESBL-PE carriage was associated with a high rate of post-biopsy UTI symptoms requiring further elucidation; however, it was not associated with microbiologically proven infections. FQ consumption before TRUSbx was also associated with post-biopsy infections.
确定经直肠超声引导下活检（TRUSbx）患者中产超广谱β-内酰胺酶（ESBL）肠杆菌科细菌（PE）的粪便携带率及其与活检后感染的关系。
2008年至2010年期间在4家不同的三级医院进行了一项前瞻性临床研究。纳入400名因怀疑前列腺癌而将接受TRUSbx且尿液无菌的男性患者，并在活检后随访14天。在手术前立即采集直肠拭子培养标本。记录人口统计学数据、预防措施选择、过去2个月内喹诺酮或任何其他抗生素的使用情况、前列腺炎病史、重复活检、重症监护病房入住情况、住院情况、尿道插管、糖尿病（DM）和类固醇使用情况。
19%的患者检测到ESBL携带，且与过去2个月内使用喹诺酮有关；过去2个月内使用其他抗生素和DM被发现有显著相关性（P<.05）。活检后第三天有9%的患者出现有症状的尿路感染（UTI），且与活检前使用氟喹诺酮（FQ）有关。虽然ESBL-PE携带与活检后UTI症状有关，但未发现与活检后有症状的UTI有关。活检后有2名患者（0.5%）出现尿脓毒症，且这两名患者均为ESBL-PE携带者。
ESBL-PE的存在与活检前的DM和FQ使用有关。ESBL-PE携带与活检后UTI症状的高发生率有关，需要进一步阐明；然而，它与微生物学证实的感染无关。TRUSbx前使用FQ也与活检后感染有关。
