Hasanzadeh Amir, Pourmand Mohammad Reza, Alizadeh Ahad, Pourmand Gholamreza
Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Urol J. 2017 May 23;14(3):3085-3090.
To determine the prevalence of fluoroquinolone-resistant (FQR) bacteria carriage in patients undergoing transrectal ultrasound prostate biopsy (TRUS-Bx), and the relationship between the risk factors and FQR carriers as well as infections after prostate biopsy.
Rectal swabs were obtained from 158 patients undergoing TRUS-Bx. The FQR organisms were isolated using selective media, and the antibiotic susceptibility pattern was determined. Moreover, after prostate biopsy, blood and urine samples were collected from patients with post-biopsy infection (PBI) during 30days of follow up.
In total, 73 (46.2%) patients were positive for ciprofloxacin-resistant bacteria in rectal cultures. The most dominant isolates were Escherichia coli (95.9%). The antibiotic susceptibility patterns for the FQR rectal and clinical isolates showed high levels of resistance to ampicillin (94%) and trimethoprim-sulfamethoxazole (89.5%), while the resistance to amikacin, fosfomycin and imipenem remained very low. The multivariate analysis showed that previous use of FQs (OR, 2.54; 95% CI, 1.17-5.49; P = .019) and history of hospitalization (OR, 7.85; 95% CI, 2.075-29.744; P = .002) were significantly risk factors for the FQR carriage. On the other hand, the risk of PBI was higher among intestinal carriers of fluoroquinolone resistant bacteria compared with noncarriers, that this difference was statistically significant (24% versus 3.5%, P < .001).The rates of PBI and hospitalization after TRUS-Bx were 12.5%, and 4.43%, respectively.
An increase in the rectal FQR bacteria carriage is associated with elevated PBI, which strongly recommendsthe need for an appropriate prophylaxis to reduce infections in patients undergoing TRUS-Bx.
确定经直肠超声引导下前列腺穿刺活检（TRUS-Bx）患者中耐氟喹诺酮（FQR）细菌携带情况，以及危险因素与FQR携带者之间的关系，以及前列腺活检后的感染情况。
从158例行TRUS-Bx的患者中获取直肠拭子。使用选择性培养基分离FQR微生物，并确定抗生素敏感性模式。此外，在前列腺活检后，对活检后感染（PBI）患者在随访30天内采集血液和尿液样本。
直肠培养中，共有73例（46.2%）患者对环丙沙星耐药菌呈阳性。最主要的分离菌株是大肠埃希菌（95.9%）。FQR直肠和临床分离株的抗生素敏感性模式显示，对氨苄西林（94%）和甲氧苄啶-磺胺甲恶唑（89.5%）的耐药水平较高，而对阿米卡星、磷霉素和亚胺培南的耐药率仍然很低。多因素分析显示，既往使用氟喹诺酮类药物（OR，2.54；95%CI，1.17-5.49；P = 0.019）和住院史（OR，7.85；95%CI，2.075-29.744；P = 0.002）是FQR携带的显著危险因素。另一方面，耐氟喹诺酮类细菌肠道携带者的PBI风险高于非携带者，差异具有统计学意义（24%对3.5%，P < 0.001）。TRUS-Bx后PBI和住院率分别为12.5%和4.43%。
直肠FQR细菌携带增加与PBI升高相关，这强烈建议需要采取适当的预防措施以减少TRUS-Bx患者的感染。
