Prevalence of antimicrobial resistance in normal rectal flora of patients undergoing transrectal ultrasonography‐guided prostate biopsy in Korea

Abstract

Objectives:To determine the prevalence of antimicrobial resistance in the normal rectal flora of patients undergoing transrectal ultrasonography-guided prostate biopsy in Korea. Methods: Between May 2010 and October 2010, rectal swabs were cultured from patients before transrectal ultrasonography-guided prostate biopsy in three tertiary referral centers of Jeonbuk Province, Korea. Rectal swabs were collected using cotton-tipped culture swabs in a standard collection system immediately before prostate biopsy. The swabs were cultured on eosin methylene blue and McConkey agar at 37°C. Antimicrobial sensitivity tests were carried out according to National Committee for Clinical Laboratory Standards guidelines. Results: Of the 160 patients who had a rectal swab taken before prostate biopsy, microorganisms were isolated in 125 patients. Escherichia coli was isolated from the rectal swabs of 95 patients. The mean age was 68.1 years, the median serum prostate specific antigen was 5.6 ng/mL and the mean prostate volume measured by transrectal ultrasonography was 43.8 mL. Of the E. coli, 33.7%, 29.1%, 26.7%, 23.3%, 12.8%, 9.3%, 5.8%, 1.2% and 0% were resistant to ampicillin, piperacillin, levofloxacin, trimethoprim sulfamethoxazole, gentamicin, cephalothin, cefotaxim, amikacin and meropenem, respectively. Conclusions: There is a high level of resistance to ciprofloxacin and ampicillin, and a very low level of resistance to amikacin in the E. coli in the bowel flora. The prevalence of resistance to ciprofloxacin in Korea is significantly higher than that reported in Western countries.

Fluoroquinolone-based antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided prostate biopsy

“…In relation to the data published by Liss et al (18 %, California, USA), S Taylor et al (19.0 %, Vancouver, Canada), AK Taylor et al (19.6 %, Chicago, USA), Steensels et al (22 %, Leuven, Belgium) and Lee at al. (26.7 %, Jeonbuk Province, Korea), our results are more than twice as low (9.62 %) [ 15 , 20 – 23 ]. Only the results reported by Batura et al (10.6 % London, UK) appear comparable [ 24 ].…”

Prostate Biopsy-related Infection: A Systematic Review of Risk Factors, Prevention Strategies, and Management Approaches

“…Fluoroquinolone resistance in E. coli blood stream isolates has been reported to average 12% in the United States and 20% in Europe, with known fluctuation between 10 and 45% secondary to regional differences 4 . The prevalence of fluoroquinolone resistance has been observed to be higher in Asian countries (26.7 -92%) 44,45 .…”

Prevention of infectious complications after prostate biopsy procedure

“…It is known that approximately 20% of the bacterial flora in the rectum of patients undergoing a biopsy is composed of quinolone‐resistant E. coli , which is especially problematic for a transrectal procedure, as the biopsy needle transits through the rectum. In Korea, a country in the same part of Asia as Japan, the frequency of quinolone‐resistant bacteria is 26.7%, which is greater than that reported in Western countries . Furthermore, a prospective study carried out at a single facility in Thailand found that when a rectal swab was carried out before a prostate biopsy procedure, 92.3% of the Gram‐negative bacilli detected were quinolone‐resistant bacteria …”

“…In Korea, a country in the same part of Asia as Japan, the frequency of quinolone-resistant bacteria is 26.7%, which is greater than that reported in Western countries. 36 Furthermore, a prospective study carried out at a single facility in Thailand found that when a rectal swab was carried out before a prostate biopsy procedure, 92.3% of the Gram-negative bacilli detected were quinolone-resistant bacteria. 9 Taylor et al compared the incidence of infectious disease after a rectal biopsy between 112 patients who underwent a rectal swab culture before the procedure and 345 who did not.…”