Antibiotic susceptibility of intestinal <i>Escherichia coli</i> in men undergoing transrectal prostate biopsies: a prospective, registered, multicentre study

Knaapila, Juha; Kallio, Heini; Hakanen, Antti; Syvänen, Kari; Ettala, Otto; Kähkönen, Esa; Lamminen, Tarja; Seppänen, Marjo; Jambor, Ivan; Rannikko, Antti; Riikonen, Jarno; Munukka, Eveliina; Eerola, Erkki; Gunell, Marianne; Boström, Peter J.

doi:10.1111/bju.14198

Cited by 16 publications

(13 citation statements)

References 29 publications

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“…Our ESBL prevalence was quite low when compared with neighbouring countries . A recent study from Finland also discovered much higher rates of resistant organisms . It has previously been shown that ESBL rates vary widely among countries.…”

Section: Discussioncontrasting

confidence: 40%

Extended‐spectrum β‐lactamase in the rectal flora of patients undergoing transrectal prostate biopsy: a study of the prevalence in a major metropolitan hospital

et al. 2019

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ObjectivesTo determine the prevalence of extended-spectrum blactamase (ESBL) in patients undergoing transrectal prostate biopsy, to assess the incidence of postoperative sepsis, to correlate the development of sepsis with the presence of preoperative ESBL on rectal swabs, and to assess the adequacy of prophylactic antibiotic guidelines in the context of local ESBL prevalence. MethodsPatients undergoing transrectal ultrasonography (TRUS)guided biopsy at the Royal Melbourne Hospital between January 2012 and July 2016 had rectal swabs taken immediately prior to TRUS with specific cultures to identify the presence of ESBL. Patients were given a prophylactic antibiotic, 500 mg oral ciprofloxacin, 1 h before the TRUS procedure. Data were collected prospectively, with retrospective review of all readmitted patient files and audit data to ensure complete capture of events. ResultsA total of 387 TRUS-guided biopsy procedures were performed. Rectal swabs were correctly collected in 352 patients (91%). The median patient age was 65 years. In all, 25 (7%) ESBL-positive swabs were identified. Most ESBL were Escherichia coli. Half (50%) of ESBL were resistant to ciprofloxacin and all were sensitive to meropenem. A small increase in ESBL prevalence over time was not significant (R 2 = 0.35). Four patients (1.1%) were readmitted with sepsis; ESBL Pseudomonas had previously grown in one patient, but sepsis was attributable to non-ESBL E. coli. In one of the readmitted patients ESBL E. coli was present, but this patient did not have ESBL preoperatively. There were no deaths or high-dependency/intensive care unit admissions. ConclusionsThis study represents the largest Australian series to investigate ESBL prevalence, and reveals a rate lower than that of many other nations. Our sepsis rate is lower than many international series, perhaps because of our low ESBL rate and strict antibiotic prophylaxis. Preoperative swab results did not predict postoperative sepsis, and the process was therefore not useful for guiding antibiotic therapy. In this patient population, TRUS biopsy, with ciprofloxacin prophylaxis, remains a safe option for diagnostic prostate biopsy.

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Section: Discussioncontrasting

confidence: 40%

Extended‐spectrum β‐lactamase in the rectal flora of patients undergoing transrectal prostate biopsy: a study of the prevalence in a major metropolitan hospital

et al. 2019

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“…12,13 Cases of ESBL-producing E. coli bacteraemia have been reported after prostate biopsies 17 and international travel has been identified as the risk factor for fluoroquinolone-resistant and ESBL-producing E. coli infections. 16,61 Therefore, the role of screening and contact precaution of returned travellers from clinical and public health perspectives need to be further examined. 62 It is unfeasible to screen all returning travellers, but in a healthcare setting, it may be feasible to screen those who are planning to undergo higher risk medical procedures; although current evidence suggest that ESBL- producing E. coli is less likely to spread between patients in hospitals than other Enterobacterales species.…”

Section: Acute Diarrhoea Is the Most Common Condition Affecting Travementioning

confidence: 99%

Risk factors for acquisition of multidrug-resistant Enterobacterales among international travellers: a synthesis of cumulative evidence

Furuya‐Kanamori

Stone

Yakob

et al. 2019

Journal of Travel Medicine

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Background Recent studies have shown that over 50% of people travelling to Southeast Asia return colonized with multidrug-resistant Enterobacterales (MRE) including carbapenemase-producing Enterobacterales. Importation of MRE by travellers and subsequent spread to family members, communities and healthcare facilities poses real risks that have not yet been adequately assessed. This systematic review and meta-analysis aims to quantify the risk factors and interventions for reducing the risk of MRE acquisition among international travellers. Methods A systematic search was conducted in PubMed, Web of Science and Scopus for analytical epidemiological studies containing data post-2000 that assessed the risk factors to acquire and/or interventions to reduce the risk of MRE acquisition in travellers. Two researchers independently screened all the studies and extracted the information, and disagreements were resolved through consensus. The proportions of MRE acquisition by the region of destination and the odds ratio (OR) for the different risk factors and/or interventions were pooled using the inverse variance heterogeneity model. Results A total of 20 studies (5253 travellers from high-income countries) were included in the meta-analysis. South Asia [58.7%; 95% confidence interval (CI), 44.5–72.5%] and Northern Africa (43.9%; 95% CI 37.6–50.3%) were the travel destinations with the highest proportion of MRE acquisition. Inflammatory bowel disease (OR 2.1; 95% CI 1.2–3.8), use of antibiotics (OR 2.4; 95% CI 1.9–3.0), traveller’s diarrhoea (OR 1.7; 95% CI 1.3–2.3) and contact with the healthcare system overseas (OR 1.5; 95% CI 1.1–2.2) were associated with MRE colonization. Vegetarians (OR 1.4; 95% CI 1.0–2.0) and backpackers (OR 1.5; 95% CI 1.2–1.8) were also at increased odds of MRE colonization. Few studies (n = 6) investigated preventive measures and found that consuming only bottled water/beverages, meticulous hand hygiene and probiotics had no protective effect on MRE colonization. Conclusions International travel is an important driver for MRE spread worldwide. Future research needs to identify effective interventions to reduce the risk of MRE acquisition as well as design strategies to reduce local transmission on return.

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“…All prostate biopsies were performed transrectally by experienced urologists ( n = 7) without enema and with periprostatic block. Antibiotic prophylaxis and biopsy-related complications have been recently reported [18,19]. For each man with at least 1 IMPROD Likert score 3–5 lesion, the biopsy procedure started with a TB.…”

Section: Methodsmentioning

confidence: 99%

Validation of IMPROD biparametric MRI in men with clinically suspected prostate cancer: A prospective multi-institutional trial

et al. 2019

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Background Magnetic resonance imaging (MRI) combined with targeted biopsy (TB) is increasingly used in men with clinically suspected prostate cancer (PCa), but the long acquisition times, high costs, and inter-center/reader variability of routine multiparametric prostate MRI limit its wider adoption. Methods and findings The aim was to validate a previously developed unique MRI acquisition and reporting protocol, IMPROD biparametric MRI (bpMRI) (NCT01864135), in men with a clinical suspicion of PCa in a multi-institutional trial (NCT02241122). IMPROD bpMRI has average acquisition time of 15 minutes (no endorectal coil, no intravenous contrast use) and consists of T2-weighted imaging and 3 separate diffusion-weighed imaging acquisitions. Between February 1, 2015, and March 31, 2017, 364 men with a clinical suspicion of PCa were enrolled at 4 institutions in Finland. Men with an equivocal to high suspicion (IMPROD bpMRI Likert score 3–5) of PCa had 2 TBs of up to 2 lesions followed by a systematic biopsy (SB). Men with a low to very low suspicion (IMPROD bpMRI Likert score 1–2) had only SB. All data and protocols are freely available. The primary outcome of the trial was diagnostic accuracy—including overall accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value—of IMPROD bpMRI for clinically significant PCa (SPCa), which was defined as a Gleason score ≥ 3 + 4 (Gleason grade group 2 or higher). In total, 338 (338/364, 93%) prospectively enrolled men completed the trial. The accuracy and NPV of IMPROD bpMRI for SPCa were 70% (113/161) and 95% (71/75) (95% CI 87%–98%), respectively. Restricting the biopsy to men with equivocal to highly suspicious IMPROD bpMRI findings would have resulted in a 22% (75/338) reduction in the number of men undergoing biopsy while missing 4 (3%, 4/146) men with SPCa. The main limitation is uncertainty about the true PCa prevalence in the study cohort, since some of the men may have PCa despite having negative biopsy findings. Conclusions IMPROD bpMRI demonstrated a high NPV for SPCa in men with a clinical suspicion of PCa in this prospective multi-institutional clinical trial. Trial registration ClinicalTrials.gov NCT02241122 .

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Antibiotic susceptibility of intestinal Escherichia coli in men undergoing transrectal prostate biopsies: a prospective, registered, multicentre study

Cited by 16 publications

References 29 publications

Extended‐spectrum β‐lactamase in the rectal flora of patients undergoing transrectal prostate biopsy: a study of the prevalence in a major metropolitan hospital

Extended‐spectrum β‐lactamase in the rectal flora of patients undergoing transrectal prostate biopsy: a study of the prevalence in a major metropolitan hospital

Risk factors for acquisition of multidrug-resistant Enterobacterales among international travellers: a synthesis of cumulative evidence

Validation of IMPROD biparametric MRI in men with clinically suspected prostate cancer: A prospective multi-institutional trial

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