Occurrence and significance of fluoroquinolone-resistant and ESBL-producing and complex of the rectal flora in Ghanaian patients undergoing prostate biopsy.

BACKGROUND

Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B).

OBJECTIVES

We investigated the relationship between carriage of FQ-resistant and ESBL-producing and complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications.

METHODS

From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors.

RESULTS

Overall, 86.4% ( = 312/361) and 62.6% ( = 226/361) of patients carried FQ-resistant and ESBL-producing and complex, respectively. Approximately 60% ( = 289/483) of the FQ-resistant and 66.0% ( = 202/306) of the ESBL-positive isolates exhibited resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal and complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% ( = 11/361), with an overall high probability (96.9%) of staying free of infections within the 30 day period post-TRUS-B. Antibiotic use in the previous 3 months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive and complex comprised an independent risk factor for post-biopsy infectious complications.

CONCLUSIONS

The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.