Korkmaz Nesibe, Gurbuz Yunus, Sandikci Fatih, Kul Gülnur, Tutuncu Emin Ediz, Sencan Irfan
Department of Infectious Diseases and Clinical Microbiology, Kahramankazan State Hospital, Ankara 06080, Turkey.
Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara 06080, Turkey.
Urol J. 2020 Mar 16;17(2):192-197. doi: 10.22037/uj.v0i0.4755.
To evaluate ciprofloxacin resistance (CR) and extended-spectrum beta-lactamase (ESBL) positivity in the rectal flora, antibiotic prophylaxis received, and post-biopsy infectious complications in patients undergoing prostate biopsy.
MATERIAL & METHODS: Rectal swab samples collected from 99 patients suspected of prostate cancer two days before prostate biopsy were tested for microbial susceptibility and ESBL production. All patients were given standard ciprofloxacin and ornidazole prophylaxis. Ten days post-biopsy, the patients were contacted by phone and asked about the presence of fever and/or symptoms of urinary tract infection.
Escherichia coli (E.coli) was the most common isolate detected in 82 (75%) of the rectal swab samples. Ciprofloxacin resistance was detected in 33% and ESBL positivity in 22% of the isolated E.coli strains. No microorganisms other than E.coli were detected in blood, urine, and rectal swab cultures of patients who developed post-biopsy complications. CR E.coli strains also showed resistance to other antimicrobial agents. The lowest resistance rates were to amikacin (n = 2, 7.4%) and nitrofurantoin (n = 1, 3.7%). Seven patients (7.6%) developed infectious complications. There was no significant difference in probability of hospitalization between patients with CR strains (14.3%) and those with ciprofloxacin-susceptible strains (14.3% vs. 4.7%; p = 0.194). However, strains that were both CR and ESBL-positive were associated with significantly higher probability of hospitalization compared to ciprofloxacin-susceptible strains (28.6% vs. 3.8%; p = 0.009).
The higher rate of infectious complications with CR and ESBL-positive strains suggests that the agents used for antibiotic prophylaxis should be reevaluated. It is important to consider local resistance data when using extended-spectrum agents to treat patients presenting with post-biopsy infectious complications.
评估接受前列腺活检患者的直肠菌群中对环丙沙星的耐药性（CR）及超广谱β-内酰胺酶（ESBL）阳性情况、接受的抗生素预防措施以及活检后感染并发症。
对99例疑似前列腺癌患者在前列腺活检前两天采集的直肠拭子样本进行微生物敏感性和ESBL产生情况检测。所有患者均接受标准的环丙沙星和奥硝唑预防治疗。活检后10天，通过电话联系患者，询问其是否有发热和/或尿路感染症状。
在82份（75%）直肠拭子样本中检测到的最常见分离菌为大肠杆菌（E.coli）。在分离出的大肠杆菌菌株中，33%检测到对环丙沙星耐药，22%为ESBL阳性。发生活检后并发症的患者的血液、尿液和直肠拭子培养物中未检测到除大肠杆菌以外的其他微生物。CR大肠杆菌菌株对其他抗菌药物也表现出耐药性。最低耐药率见于阿米卡星（n = 2，7.4%）和呋喃妥因（n = 1，3.7%）。7例患者（7.6%）发生感染并发症。CR菌株患者的住院概率（14.3%）与环丙沙星敏感菌株患者（14.3%对4.7%；p = 0.194）之间无显著差异。然而，与环丙沙星敏感菌株相比，CR且ESBL阳性的菌株与显著更高的住院概率相关（28.6%对3.8%；p = 0.009）。
CR和ESBL阳性菌株导致的感染并发症发生率较高，提示应重新评估用于抗生素预防的药物。在使用广谱药物治疗出现活检后感染并发症的患者时，考虑当地的耐药数据很重要。
