Widespread use of fluoroquinolone prophylaxis may be associated with an increase in resistant Escherichia coli strains , posing a potentially major health issue in the future .
INTRODUCTION Transrectal ultrasound-guided biopsies ( TRUS-gb ) are associated with both mild and serious complications .
Prophylactic antibiotics reduce the risk of septicaemia and mortality ; however , no international consensus exists on the timing and duration of antibiotics , including the optimal drug strategy .
We review ed the current evidence supporting use of prophylactic antibiotics and the risk of complications following prostate biopsies .
Acute bacterial prostatitis after transrectal ultrasound-guided prostate biopsy: epidemiological, bacteria and treatment patterns from a 4-year prospective study.
OBJECTIVES To evaluate the incidence , and clinical and bacterial features of iatrogenic prostatitis within 1 month after  transrectal ultrasound-guided biopsy  for detection of prostate cancer . METHODS From January 2006 to December 2009 , 3000 patients underwent a 21-core transrectal ultrasound-guided prostate biopsy at Henri Mondor Hospital ( Créteil , France ) and were prospect ively followed . All patients had a fluoroquinolone antimicrobial prophylaxis for 7 days . The primary study end-point was to evaluate the incidence of iatrogenic acute prostatitis within 1 month after the biopsy . The secondary end-point was to analyze the clinical and the bacterial features of the prostatitis . RESULTS Overall , 20 patients of the entire study population ( 0.67 % ) had an acute bacterial prostatitis within 2.90 ± 1.77 days ( range 1 - 7 days ) after the transrectal ultrasound-guided biopsy . The groups of patients with ( n = 20 ) and without ( n = 2980 ) infection were similar in terms of age , prostate-specific antigen level and prostate volume . Escherichia coli was the only isolated bacteria . The subsequent tests for antibiotic susceptibility showed a 95 % resistance for fluroquinolone and amoxicillin . Resistance to amoxiclav , trimethoprim-sulfamethoxazole , third generation cephalosporin and amikacin was 70 % , 70 % , 25 % and 5 % respectively . No resistance to imipenem was reported . They were all admitted for treatment without the need of intensive care unit referral . Complete recovery was achieved after 21.4 ± 7 days of antibiotic treatment . CONCLUSIONS A fluroquinolone-based regimen still represents an appropriate prophylaxis protocol to minimize the risk of acute prostatitis secondary to prostate biopsy . Patients should be provided the appropriate care soon after the onset of the symptoms . An intravenous third generation cephalosporin or imipenem-based therapy seem to provide satisfying results
Widespread use of fluoroquinolone prophylaxis may be associated with an increase in resistant Escherichia coli strains , posing a potentially major health issue in the future .
INTRODUCTION Transrectal ultrasound-guided biopsies ( TRUS-gb ) are associated with both mild and serious complications .
Prophylactic antibiotics reduce the risk of septicaemia and mortality ; however , no international consensus exists on the timing and duration of antibiotics , including the optimal drug strategy .
We review ed the current evidence supporting use of prophylactic antibiotics and the risk of complications following prostate biopsies .