-

Abstract

Objective: This study aimed to address the prevalence, the risk factors and the results of fecal carriage of extended-spectrum betalactamase producing Enterobacteriaceae (ESBL-PE) in patients who had undergone transrectal needle biopsy of the prostate (TRNBP). Patients and Methods: A total of 143 patients who had undergone TRNBP were included. Of these, 33(23%) had fecal carriage of ESBL-PE. The mean age of the patients was 62 ± 7.5 (43-81) years. Results: A univariate analysis showed that quinolone or other antibiotic use within the last 2 months, prostatitis, and diabetes mellitus (DM) were significantly associated with the presence of ESBL-PE. A multivariate analysis showed that quinolone use within the past 2 months (OR: 4.865; CI: 1.45-16.1), and DM (OR: 4.04; CI: 1.64-10) were found to be significant. Development of dysuria (p<0.001), fever (p=0.046) and chills (p=0.002) after TRNBP were shown to be related to the presence of ESBL-PE . There was no asymptomatic bacteriuria and sepsis, the rate of symptomatic urinary tract infection was 19%. Conclusion: This study showed that pre-biopsy risk factors for the presence of ESBL-PE were quinolone or other antibiotic use within the last 2 months and presence of DM. Changing prophylactic regimens should not be recommended due to the low rate of severe complications.

Keywords

• Extended-spectrum beta-lactamases, Transrectal needle biopsy of the prostate, Fecal carriage, Infection

Geniş spektrumlu beta laktamaz üreten Enterobacteriaceae taşıyıcılığının prostatın transrectal iğne biyopsisi sonuçlarına etkisi

Abstract

Amaç: Bu çalışmada, transrektal prostat biyopsisi (TRPB) öncesi, hastalarda dışkıda geniş spektrumlu beta-laktamaz üreten Enterobacteriaceae (GSBL-ÜE) taşıyıcılığı oranları, risk faktörleri ve sonuçları gösterilmesi amaçlanmıştır. Hastalar ve Yöntem: Toplam 143 TRPB yapılan hasta çalışmaya alınmıştır. Bunların 33(%23)’ünde GSBL-ÜE taşıyıcılığı bulunmuştur. Ortalama hasta yaşı 62 ± 7,5 (43-81)dir. Bulgular: Tek değişkenli analizle son 2 ayda kinolon veya başka bir antibiyotik kullanımı, prostatit ve diabetes mellitus (DM) GSBL-ÜE taşıyıcılığı ile ilşkili bulunmuştur. Çok değişkenli analiz, son 2 ayda kinolon kullanımı (OR: 4,865; CI: 1,45-16,1), ve DM (OR: 4,04; CI: 1,64-10) varlığını önemli faktörler olarak göstermiştir. TRPB sonrası disüri (p

Keywords

• Geniş spektrumlu beta-laktamaz, Transrektal prostat iğne biopsisi, Fekal taşıyıcılık, Enfeksiyon

References

1. 1. Pitout JDD, Nordmann P, Laupland KB, et al. Emergence of Enterobacteriaceae-producing extended-spectrum beta- lactamases (ESBLs) in the community. J Antimicrob Chemother 2005;56:52–9. doi: 10.1093/jac/dki166.
2. 2. Valverde A, Coque TM, Sánchez-Moreno MP, Rollán A, Baquero F, Cantón R. Dramatic increase in prevalence of fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae during nonoutbreak situations in Spain. J Clin Microbiol 2004;42:4769- 75.
3. 3. Woerther PL, Angebault C, Jacquier H, Hugede HC. Massive increase, spread, and exchange of extended spectrum β-lactamase-encoding genes among intestinal Enterobacteriaceae in hospitalized children with severe acute malnutrition in Niger. Clin Infect Dis 2011;53:677- 85. doi: 10.1093/cid/cir522.
4. 4. Pallecchi L, Bartoloni A, Fiorelli C, et al. Rapid dissemination and diversity of CTX-M extended-spectrum betalactamase genes in commensal Escherichia coli from healthy children from lowresource settings of Latin America. Antimicrob Agents Chemother 2007;51:2720–5. doi:10.1128/AAC.00026-07.
5. 5. Azap Kurt O, Arslan H, Karaman S, Togan T. Risk factors for fecal carriage of extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella spp. in the community. Turk J Med Sci 2007; 37 : 31-8.
6. 6. Thompson PM, Talbot RW, Packham DA, Dulake C. Transrectal biopsy of the prostate and bacteraemia. Br J Surg 1980; 67:127–8.
7. 7. Lindstedt S, Lindström U, Ljunggren E, Wullt B, Grabe M. Singledose antibiotic prophylaxis in core prostate biopsy: Impact of timing and identification of risk factors. Eur Urol 2006;50:832-7.
8. 8. Aus G,Ahlgren G, Bergdahl S, Hugosson J. Infection after transrectal core biopsies of the prostate: risk factors and antibiotic prophylaxis. Br J Urol 1996;77:851-5.

9. 9. Valverde A, Grill F, Coque TM, et al. High rate of intestinal colonization with extended-spectrum-beta-lactamase-producing organisms in household contacts of infected community patients. J Clin Microbiol 2008;46:2796-9. doi: 10.1128/JCM.01008-08.
10. 10. Ben Sallem R, Ben Slama K, Estepa V, et al. Prevalence and characterisation of extended-spectrum beta-lactamase (ESBL)- producing Escherichia coli isolates in healthy volunteers in Tunisia. Eur J Clin Microbiol Infect Dis 2012; 31:1511-6. doi: 10.1007/ s10096-011-1471-z
11. 11. Vinué L, Sáenz Y, Martínez S, et al. Prevalence and diversity of extended spectrum beta-lactamases in faecal Escherichia coli isolates from healthy humans in Spain. Clin Microbiol Infect 2009;15:954–6. doi: 10.1111/j.1469-0691.2009.02803.x.
12. 12. Rodriguez-Bano J, Lopez-Cerero L, Navarro MD, Diaz de Alba P. Faecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli: prevalence, risk factors and molecular epidemiology. J Antimicrob Chemother 2008;62:1142-9. doi: 10.1093/jac/dkn293.
13. 13. Ruddick F, Sanders P, Bicknell SG, Crofts P. Sepsis rates after ultrasound-guided prostate biopsy using a bowel preparation protocol in a community hospital. J Ultrasound Med 2011;30:213-6.
14. 14. Silva N, Oliveira M, Bandeira AC, Brites C. Risk factors for infection by extended-spectrum beta-lactamase producing Klebsiella pneumoniae in a tertiary hospital in Salvador, Brazil. Braz J Infect Dis 2006;10:191-3.
15. 15. Rodriguez-Bano J, Navarro MD, Romero L, et al. Epidemiology and clinical features of infections caused by extended-spectrum betalactamase-producing escherichia coli in nonhospitalized patients. J Clin Microbiol 2004;42:1089-94.