• Matthew J Roberts, Deborah A Williamson, Paul Hadway, Suhail A R Doi, Robert A Gardiner, and David L Paterson.
• Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. Electronic address: m.roberts2@uq.edu.au.
• Int. J. Antimicrob. Agents. 2014 Apr 1; 43 (4): 301-9.

AbstractTransrectal ultrasound-guided prostate biopsy (TRUSPB) is a commonly performed urological procedure. Recent studies suggest that pre-biopsy screening for fluoroquinolone-resistant (FQ-R) pathogens may be useful in reducing post-biopsy infections. We sought to determine the baseline prevalence of fluoroquinolone (FQ) resistance in rectal flora and to investigate the relationship between pre-biopsy carriage of FQ-R pathogens and the risk of post-TRUSPB infection. Electronic databases were searched for related literature. Studies were assessed for methodological quality and comparable outcomes prior to meta-analysis (using quality- and random-effects models). Nine studies, representing 2541 patients, were included. The prevalence of FQ resistance was higher (20.4%, 95% CI 18.2-22.6%) in rectal cultures obtained following FQ-based prophylaxis compared with those obtained before (12.8%, 95% CI 10.7-15.0%). Overall infection rates in patients using empirical prophylaxis were higher (3.3%, 95% CI 2.6-4.2%) than in those using altered (targeted/protocol) regimens (0.3%, 95% CI 0-0.9%). Higher infection rates were seen in men with FQ-R rectal cultures (7.1%, 95% CI 4.0-10.5%) than in those with FQ-sensitive (FQ-S) rectal cultures (1.1%, 95% CI 0.5-1.8%). For every 14 men with FQ-R rectal cultures, one additional infection was observed compared with men with FQ-S rectal cultures. Prior FQ use and prior genitourinary infection were significant risk factors for FQ-R colonisation. FQ resistance in rectal flora is a significant predictor of post-TRUSPB infection and may require re-assessment of empirical antimicrobial prophylaxis methods. Altered prophylaxis based on rectal culturing prior to TRUSPB may reduce morbidity and potentially provide economic benefits to health services. Copyright © 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

27 keywords...

hide…