Saade Elie A, Suwantarat Nuntra, Zabarsky Trina F, Wilson Brigid, Donskey Curtis J
Infectious Diseases Division, University Hospitals, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.
Pathog Immun. 2016;1(2):243-257. doi: 10.20411/pai.v1i2.123.
Recent reports suggest that infections due to fluoroquinolone-resistant are an increasingly common complication of transrectal biopsy of the prostate (TBP) in the United States. A better understanding of the magnitude and scope of these infections is needed to guide prevention efforts. Our objective is to determine whether the incidence of infections due to fluoroquinolone-resistant after TBP has increased nationwide in the Veterans Affairs Health Care System and to identify risk factors for infection.
We performed a retrospective, observational cohort study and a nested case-control study within the US Deparment of Veterans Affairs Healthcare System. The primary outcomes were the incidence of urinary tract infection (UTI) and bacteremia with and with fluoroquinolone- resistant strains within 30 days after TBP. Secondary endpoints focused on the correlation between fluoroquinolone-resistance in all urinary isolates and post-TBP infection and risk factors for infection due to fluoroquinolone-resistant infection.
245 618 patients undergoing 302 168 TBP procedures from 2000 through 2013 were included in the cohort study, and 59 469 patients undergoing TBP from 2011 through 2013 were included in the nested case-control study. Between 2000 and 2013, there was a 5-fold increase in the incidence of UTI (0.18%-0.93%) and a 4-fold increase in the incidence of bacteremia (0.04%-0.18%) after TBP that was attributable to an increase in the incidence of fluoroquinolone- resistant UTI (0.03%-0.75%) and bacteremia (0.01%-0.14%). The increasing incidence of fluoroquinolone-resistant infections after TBP occurred in parallel with increasing rates of fluoroquinolone-resistance in all urinary isolates. By multivariable logistic regression analysis, independent risk factors for fluoroquinolone-resistant UTI after TBP included diabetes mellitus, fluoroquinolone exposure, prior hospitalization, and prior cultures with fluoroquinolone-resistant gram-negative bacilli.
In the Veterans Affairs Healthcare System, the incidence of infection after TBP has increased significantly since 2000 due to a dramatic rise in infections with fluoroquinolone- resistant .
近期报告显示，在美国，耐氟喹诺酮菌感染是经直肠前列腺活检（TBP）后日益常见的并发症。为指导预防工作，需要更好地了解这些感染的严重程度和范围。我们的目标是确定在退伍军人事务医疗保健系统中，TBP后耐氟喹诺酮菌感染的发生率在全国范围内是否有所增加，并确定感染的风险因素。
我们在美国退伍军人事务医疗保健系统内进行了一项回顾性观察队列研究和一项巢式病例对照研究。主要结局是TBP后30天内耐氟喹诺酮菌和非耐氟喹诺酮菌引起的尿路感染（UTI）和菌血症的发生率。次要终点集中在所有尿分离株中氟喹诺酮耐药性与TBP后感染之间的相关性以及耐氟喹诺酮菌感染的危险因素。
队列研究纳入了2000年至2013年接受302168次TBP手术的245618例患者，巢式病例对照研究纳入了2011年至2013年接受TBP的59469例患者。在2000年至2013年期间，TBP后耐氟喹诺酮菌UTI（0.03%-0.75%）和菌血症（0.01%-0.14%）发生率的增加导致UTI发生率（0.18%-0.93%）增加了5倍，菌血症发生率（0.04%-0.18%）增加了4倍。TBP后耐氟喹诺酮菌感染发生率的增加与所有尿分离株中氟喹诺酮耐药率的增加同时发生。通过多变量逻辑回归分析，TBP后耐氟喹诺酮菌UTI的独立危险因素包括糖尿病、氟喹诺酮暴露、既往住院以及既往培养出耐氟喹诺酮革兰氏阴性杆菌。
在退伍军人事务医疗保健系统中，自2000年以来，由于耐氟喹诺酮菌感染的急剧增加，TBP后感染的发生率显著上升。
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