529. Fluoroquinolone Use and Association with Fluoroquinolone-Resistance in Pre-Prostate Biopsy Stool Samples and Post-Biopsy Infection
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • IDWeekWebb.pdf (632.4 kB)
  • Background: Prostate biopsies have been associated with infectious complications including cystitis, prostatitis and bacteremia. Escherichia coli (E. coli) is the most common pathogen. Ciprofloxacin is the antibiotic of choice for prophylaxis. Fluoroquinolone resistance has been associated with increasing post-biopsy infection rates. Fluoroquinolone use has been associated with the development of resistance in other settings. Methods: Our study was developed to evaluate fluoroquinolone use and the presence of ciprofloxacin-resistant E. coli, Extended-Spectrum Beta-Lactamase-producing (ESBL) E. coli, and post-biopsy infection. In order to evaluate the rate of fluoroquinolone-resistance in our facility, stool cultures were obtained on all patients the day of biopsy which were evaluated for ciprofloxacin resistance. The data collected included: date of biopsy, presence of fluoroquinolone-resistant E. coli, presence of ESBL- E. coli, and fluoroquinolone use within the prior six months. Patients with fluoroquinolone-resistance were case-matched in a 1:1 ratio with patients who had a biopsy on the same day. All patients who had a prostate biopsy from February 14, 2012 to February 14, 2013 were included. A chi-square analysis was used to determine differences between the two groups. Results: 347 patients had a pre-biopsy stool culture during the study period. Of these, 63 patients had ciprofloxacin-resistant E. coli. 49 patients were case-matched with a patient without ciprofloxacin-resistant E. coli. No significant difference was found in previous fluoroquinolone use between the two groups (p=0.754). Only five cultures contained ESBL- E. coli. The data is limited by a small sample size; however, there was no statistically significant difference in history of fluoroquinolone use (p=0.21). Four patients experienced a post-biopsy infection. Of these patients, three did not have a history of fluoroquinolone use and one patient did. Conclusion: Previous fluoroquinolone use is not a reliable method for predicting fluoroquinolone resistance in E. coli in the stool. Obtaining a stool culture prior to biopsy remains the most effective method for screening for the presence of ciprofloxacin resistance and thus for the risk of post-biopsy infection.
    Angharad Webb, PharmD, BCPS, Pharmacy, VA San Diego Healthcare System, San Diego, CA, Scott T. Johns, PharmD, BCPS, Veterans Affairs San Diego Healthcare System, San Diego, CA and Joshua Fierer, MD, Medicine, Veterans Affairs Healthcare System San Diego, University of California San Diego, San Diego, CA


    A. Webb, None

    S. T. Johns, None

    J. Fierer, None

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