Tsu James Hok-Leung, Ma Wai-Kit, Chan Wayne Kwun-Wai, Lam Bosco Hoi-Shiu, To Kim-Chung, To Wing-Kin, Ng Tak-Keung, Liu Pak-Ling, Cheung Fu-Keung, Yiu Ming-Kwong
Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
Department of Pathology, Princess Margaret Hospital, Hong Kong, China.
Urology. 2015 Jan;85(1):15-21. doi: 10.1016/j.urology.2014.07.078. Epub 2014 Nov 8.
To study the prevalence of fluoroquinolone-resistant (FQ-resistant) and extended-spectrum β-lactamase-producing (ESBL-producing) bacteria in the rectums of patients undergoing transrectal ultrasound-guided prostate biopsy (TRUS-Bx), identifying predictive factors for such carriage and to correlate with the microbiology of those who developed postbiopsy infection (PBI).
A total of 371 men undergoing TRUS-Bx were prospectively enrolled from August 2011 to March 2012. Rectal swab was obtained before antimicrobial prophylaxis on the day of biopsy and grown in selective media for resistant bacteria. Standard FQ prophylaxis was used without guidance from rectal swab results. Univariate and multivariate analyses were performed to identify predictive factors of either FQ-resistant or ESBL-producing bacteria carriage.
A total of 199 of 371 patients (53.6%) carried antimicrobial-resistant rectal flora, with 150 (40.4%) and 152 (41.0%) patients having FQ-resistant and ESBL-producing bacteria, respectively. Diabetes mellitus (odds ratio, 2.075; P = .028) and the use of antimicrobials within the prior 5 years (odds ratio, 1.550; P = .047) were independent predictors of rectal carriage of such flora. PBI occurred in 9 patients, of which 7 harbored prebiopsy antimicrobial-resistant bacteria, which completely matched the microbiological data collected during the patients' PBI episodes.
A high prevalence of FQ-resistant and ESBL-producing rectal flora in Chinese men undergoing TRUS-Bx was found. Diabetes mellitus and prior antimicrobial use within 5 years were significant predictors for resistant bacterial carriage. Despite the high-resistant bacteria prevalence, PBI rate remained low. A targeted approach of antimicrobial prophylaxis using prebiopsy culture swab in areas with high prevalence of resistant bacteria should be further investigated.
研究经直肠超声引导下前列腺穿刺活检（TRUS - Bx）患者直肠中耐氟喹诺酮（FQ耐药）和产超广谱β-内酰胺酶（ESBLs）细菌的流行情况，确定此类携带的预测因素，并与活检后感染（PBI）患者的微生物学情况相关联。
2011年8月至2012年3月前瞻性纳入371例行TRUS - Bx的男性患者。在活检当天进行抗菌预防前采集直肠拭子，并在选择性培养基中培养以检测耐药菌。采用标准的FQ预防措施，不根据直肠拭子结果进行指导。进行单因素和多因素分析以确定FQ耐药或产ESBLs细菌携带的预测因素。
371例患者中有199例（53.6%）携带耐抗菌药物的直肠菌群，分别有150例（40.4%）和152例（41.0%）患者携带FQ耐药菌和产ESBLs细菌。糖尿病（比值比，2.075；P = 0.028）和既往5年内使用抗菌药物（比值比，1.550；P = 0.047）是此类菌群直肠携带的独立预测因素。9例患者发生PBI，其中7例在活检前携带耐抗菌药物细菌，这与患者PBI发作期间收集的微生物学数据完全匹配。
发现中国行TRUS - Bx的男性患者中，直肠FQ耐药菌和产ESBLs菌群的流行率较高。糖尿病和既往5年内使用抗菌药物是耐药菌携带的重要预测因素。尽管耐药菌流行率较高，但PBI发生率仍然较低。在耐药菌高流行地区，使用活检前培养拭子进行针对性抗菌预防的方法应进一步研究。
