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The Role of Ciprofloxacin Resistance and Extended-spectrum beta-lactamase (ESBL) Positivity in Infective Complications Following Prostate Biopsy

Nesibe Korkmaz, Yunus Gurbuz, Fatih Sandikci, Gülnur Kul, Emin Ediz Tutuncu, Irfan Sencan



Purpose: 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.

Results: 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).

Conclusion: 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.


Heidenreich, A., et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent—update 2013. European urology, 2014. 65(1): p. 124-137.2

Loeb, S., et al. Systematic review of complications of prostate biopsy. European urology, 2013. 64(6): p. 876-892.

Liss, M.A., et al. The Preventıon and Treatment of The More Common Complıcatıons Related to Prostate Bıopsy Update. 2016.

Taylor, S., et al. Ciprofloxacin resistance in the faecal carriage of patients undergoing transrectal ultrasound guided prostate biopsy. BJU international, 2013. 111(6): p. 946-953.

Zowawi, H.M., et al. The emerging threat of multidrug-resistant Gram-negative bacteria in urology. Nature Reviews Urology, 2015. 12(10): p. 570-584.

Song, W., et al. Incidence and management of extended-spectrum beta-lactamase and quinolone-resistant escherichia coli infections after prostate biopsy. Urology, 2014. 84(5): p. 1001-1007.


Bennett, J.E. R. Dolin, and M.J. Blaser, Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 2014: Elsevier Health Sciences.

Pitout, J.D. , Infections with extended-spectrum β-lactamase-producing Enterobacteriaceae. Drugs, 2010. 70(3): p. 313-333.

Lautenbach, E., et al. Risk factors for fluoroquinolone resistance in nosocomial Escherichia coli and Klebsiella pneumoniae infections. Archives of Internal Medicine, 2002. 162(21): p. 2469-2477.

Williamson, D.A., et al. Infectious complications following transrectal ultrasound–guided prostate biopsy: new challenges in the era of multidrug-resistant Escherichia coli. Clinical infectious diseases, 2013. 57(2): p. 267-274.

Steensels, D., et al. Fluoroquinolone‐resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound‐guided prostate biopsy—should we reassess our practices for antibiotic prophylaxis? Clinical Microbiology and Infection, 2012. 18(6): p. 575-581.

Liss, M.A., et al. Comparative effectiveness of targeted vs empirical antibiotic prophylaxis to prevent sepsis from transrectal prostate biopsy: a retrospective analysis. The Journal of urology, 2015. 194(2): p. 397-402

Tigen, E.T., et al. Outcomes of Fecal Carriage of Extended-spectrum β-Lactamase After Transrectal Ultrasound–guided Biopsy of the Prostate. Urology, 2014. 84(5): p. 1008-1015

Kisa Erdem, et al. "Fosfomycin: a good alternative drug for prostate biopsy prophylaxis the results of a prospective, randomized trial with respect to risk factors." International braz j urol 43.6 (2017): 1068-1074.

Yagci, D., et al. Prevalence and risk factors for selection of quinolone-resistant Escherichia coli strains in fecal flora of patients receiving quinolone therapy. Antimicrobial agents and chemotherapy, 2009. 53(3): p. 1287-1289

Sieczkowski, M., et al. Fluoroquinolone-based antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided prostate biopsy. European Journal of Clinical Microbiology & Infectious Diseases, 2015. 34(9): p. 1815-1821

Minamida, S., et al. Prevalence of fluoroquinolone-resistant Escherichia coli before and incidence of acute bacterial prostatitis after prostate biopsy. Urology, 2011. 78(6): p. 1235-1239.

Tsu, J.H.-L., et al. Prevalence and Predictive Factors of Harboring Fluoroquinolone-resistant and Extended-spectrum β-Lactamase–producing Rectal Flora in Hong Kong Chinese Men Undergoing Transrectal Ultrasound-guided Prostate Biopsy. Urology, 2015. 85(1): p. 15-22.

Kehinde, E.O., et al. Combined ciprofloxacin and amikacin prophylaxis in the prevention of septicemia after transrectal ultrasound guided biopsy of the prostate. The Journal of urology, 2013. 189(3): p. 911-915.

Womble, P.R., et al. A statewide intervention to reduce hospitalizations after prostate biopsy. The Journal of urology, 2015. 194(2): p. 403-409.

Lorber, G., et al. A single dose of 240 mg gentamicin during transrectal prostate biopsy significantly reduces septic complications. Urology, 2013. 82(5): p. 998-1003.

DOI: http://dx.doi.org/10.22037/uj.v0i0.4755


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