Sepsis Due to Fluoroquinolone-resistant Escherichia coli After Transrectal Ultrasound-guided Prostate Needle Biopsy

Objectives: To report a series of patients with sepsis due to fluoroquinolone-resistant Escherichia coli after prostate needle biopsy across 4 hospitals in southern California. Methods: Five patients presented with fever and blood cultures positive for fluoroquinolone-resistant E. coli after prostate needle biopsy with pre-procedure fluoroquinolone antimicrobial prophylaxis. The cases are described and the published data reviewed. Results: Of the 5 patients, 1 was treated at Hoag Memorial Hospital in 2008, 2 were treated at the Long Beach Veterans Affairs Medical Center, 1 was treated at Kaiser Permanente Hospital in 2007, and 1 presented to University of California, Irvine, Medical Center in 2006. All patients received an oral fluoroquinolone antibiotic the morning of or 1 hour before biopsy. Of the 5 patients, 4 also received gentamicin intramuscularly before biopsy. Conclusions: The estimated incidence of sepsis was 0.1%-0.9%, assuming patients reported to the hospital at which the biopsy was performed. From a review of the published data, we recommend a fluoroquinolone antibiotic before and after biopsy for ≤24 hours. From our findings, if the patient has taken a fluoroquinolone antibiotic in the past 8 months, a second- or third-generation cephalosporin should be used or an aminoglycoside (1.5-2 mg/kg intramuscularly) with metronidazole or clindamycin. A carbapenem should be substituted if the patient has a history of infections with extended-spectrum β-lactamase producers. Cases of fluoroquinolone-resistant E. coli should be tracked in a nationalized database.