Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy

Michael A. Liss, Stephen A. Taylor, Deepak Batura, Deborah Steensels, Methee Chayakulkeeree, Charlotte Soenens, G. Gopal Rao, Atreya Dash, Samuel Park, Nishant Patel, Jason Woo, Michelle McDonald, Unwanaobong Nseyo, Pooya Banapour, Stephen Unterberg, Thomas E. Ahlering, Hendrik Van Poppel, Kyoko Sakamoto, Joshua Fierer, Peter C. Black

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Purpose Infection after transrectal prostate biopsy has become an increasing concern due to fluoroquinolone resistant bacteria. We determined whether colonization identified by rectal culture can identify men at high risk for post-transrectal prostate biopsy infection.

Materials and Methods Six institutions provided retrospective data through a standardized, web based data entry form on patients undergoing transrectal prostate biopsy who had rectal culture performed. The primary outcome was any post-transrectal prostate biopsy infection and the secondary outcome was hospital admission 30 days after transrectal prostate biopsy. We used chi-square and logistic regression statistical analysis.

Results A total of 2,673 men underwent rectal culture before transrectal prostate biopsy from January 1, 2007 to September 12, 2013. The prevalence of fluoroquinolone resistance was 20.5% (549 of 2,673). Fluoroquinolone resistant positive rectal cultures were associated with post-biopsy infection (6.6% vs 1.6%, p <0.001) and hospitalization (4.4% vs 0.9%, p <0.001). Fluoroquinolone resistant positive rectal culture increased the risk of infection (OR 3.98, 95% CI 2.37-6.71, p <0.001) and subsequent hospital admission (OR 4.77, 95% CI 2.50-9.10, p <0.001). If men only received fluoroquinolone prophylaxis, the infection and hospitalization proportion increased to 8.2% (28 of 343) and 6.1% (21 of 343), with OR 4.77 (95% CI 2.50-9.10, p <0.001) and 5.67 (95% CI 3.00-10.90, p <0.001), respectively. The most common fluoroquinolone resistant bacteria isolates were Escherichia coli (83.7%). Limitations include the retrospective study design, nonstandardized culture and interpretation of resistance methods.

Conclusions Colonization of fluoroquinolone resistant organisms in the rectum identifies men at high risk for infection and subsequent hospitalization from prostate biopsy, especially in those with fluoroquinolone prophylaxis only.

Original languageEnglish (US)
Pages (from-to)1673-1678
Number of pages6
JournalJournal of Urology
Issue number6
StatePublished - Dec 1 2014
Externally publishedYes


  • biopsy
  • drug resistance
  • infection
  • microbial
  • prostate

ASJC Scopus subject areas

  • Urology


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