1179. Incidence of Bacteremia and Bacteriuria with Antibiotic-resistant Enterobacteriaceae after Transrectal Ultrasound-Guided Biopsy of the Prostate (TRUSBP)
Session: Poster Abstract Session: Healthcare Epidemiology: MDR-Gram Negative Infections
Friday, October 5, 2018
Room: S Poster Hall
Background:

Infection with Escherichia coli after TRUSBP is common, but other Enterobacteriaceae also occur. In the absence of microbiological data, prophylaxis with co-trimoxazole (TMP-SMX) or fluoroquinolones (FQ) is usually prescribed. We estimated the incidence of bacteremia and bacteriuria after TRUSBP with distinct species of Enterobacteriaceae and their rate of resistance to common antibiotics.

Methods:

Using Veterans Healthcare Administration (VHA) databases, we identified patients undergoing TRUSBP between 1 January 2013 and 31 December 2017. We determined the incidence of Enterobacteriaceae isolated from urine and blood cultures obtained within thirty days of TRUSBP. Using microbiology data from VHA, we determined rates of resistance to TMP-SMX, FQ (ciprofloxacin as marker), ESC (ceftriaxone as marker) and carbapenems (Carb) (ertapenem as marker).

Results:

Overall, 377 (0.3%) and 1739 (1.4%) of 126,761 TRUSBPs were complicated by bacteremia or bacteriuria with Enterobacteriaceae, respectively. E. coli was predominant (91% of blood and 81% in urine). Rates of FQ resistance were low in Klebsiella and Enterobacter but exceeded 60% in E. coli. In general, TMP-SMX resistance exceeded 30%. Of note, 16.6% of blood and 11% of urine Enterobacteriacaea were resistant to ESC, while Carb-resistance was rare.

Conclusion:

FQ and ESC resistant Enterobacteriaceae are prevalent in bacteremia and bacteriuria after TRUSBP. Antibiotics used for prophylaxis and empirical treatment are likely to be ineffective. The prevention and management of TRUSBP related infections should include microbiology-guided approaches.

Total

ESC resistant

Carb resistant

FQ resistant

TMP-SMX resistant

Enterobacteriaceae

Blood

377

61

16.4%

2

0.5%

235

62.3%

129

34.2%

Urine

1739

192

11.0%

20

1.2%

986

56.7%

607

34.9%

Citrobacter

Blood

3

1

%

0

-

1

-

1

-

Urine

22

5

22.7%

2

9.1%

8

36.4%

7

31.8%

Enterobacter

Blood

4

0

0

0

0

Urine

46

8

17.4%

2

4.3%

3

6.5%

1

2.2%

Escherichia coli

Blood

344

57

16.6%

0

0.0%

232

67.4%

123

35.8%

Urine

1415

157

11.1%

2

0.1%

934

66.0%

556

39.3%

Klebsiella

Blood

24

3

12.5%

1

4.2%

2

8.3%

4

16.7%

Urine

196

14

7.1%

6

3.1%

15

7.7%

22

11.2%

Morganella

Blood

2

1

1

0

1

Urine

13

2

15.4%

5

38.5%

5

38.5%

8

61.5%

Proteus

33

6

18.2%

3

9.1%

17

51.5%

11

33.3%

Providencia

2

0

0

-

1

-

0

-

Serratia

11

0

0

2

1

Shigella

1

0

0

1

1

Elie Saade, MD, MPH, University Hospitals of Cleveland, Cleveland, OH, Khalid M. Dousa, MD, FACP, CABIM, Infectious Disease, University Hospitals, Case Western Reserve University, Cleveland, OH, Brigid Wilson, PhD, Geriatric Research, Education, and Clinical Center, Cleveland VA Medical Center, Cleveland, OH, Federico Perez, MD, MS, Louis Stokes Cleveland VA Medical Center, Cleveland, OH and Curtis J. Donskey, MD, Infectious Diseases, Case Western Reserve University, Cleveland, OH

Disclosures:

E. Saade, None

K. M. Dousa, None

B. Wilson, None

F. Perez, None

C. J. Donskey, None

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