Rectal E. coli above ciprofloxacin ECOFF associate with infectious complications following prostate biopsy
Inari Kalalahti1, Kaisa Huotari2, Kanerva Lahdensuo3
1Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. inari.kalalahti@hus.fi.
Abstract:
Transrectal prostate biopsies carry the risk of infection. By using non-selective culture plates, instead of commonly used ciprofloxacin (CIP)-containing plates, we analyzed the association between Escherichia coli CIP minimal inhibitory concentration (MIC) and post-biopsy infectious complications. A pre-biopsy rectal swab was taken from 207 consecutive men, scheduled for transrectal 12-core prostate biopsy with CIP 750 mg as the mostly used prophylaxis. CIP MIC of rectal Gram-negative bacilli was determined from a chromogenic agar. Rectal E. coli were categorized to resistant (R) and intermediate (I) isolates together (R + I, MIC > 0.25 mg/l) and to sensitive (S, MIC ≤ 0.25 mg/l) using EUCAST clinical breakpoints. In addition, epidemiological cutoff (ECOFF R, MIC > 0.064 mg/l) was used for categorization. Eighteen (8.7%) men showed CIP R + I E. coli by the EUCAST breakpoints and 41 (19.8%) using the ECOFF R criteria. During follow-up, 15 (7.2%) men had infectious symptoms, of which 9 (4.3%) were culture-confirmed infections. Only 4 (26.7%) of these 15 patients showed R + I E. coli in the rectal swab according to EUCAST, but 10 (66.7%) using the ECOFF cutoff. Rectal E. coli CIP R + I by the EUCAST clinical breakpoints associated with infectious complications with OR 5.7 (95% CI 1.5-21.8, P = 0.005) and ECOFF R E. coli by OR 10.7 (95% CI 3.0-37.6, P < 0.001). Men carrying rectal E. coli with moderately lowered CIP susceptibility (MIC > ECOFF 0.064 mg/l) were identified and, interestingly, they showed a high risk of developing infectious symptoms after the biopsy. This explains why some men develop infectious complications despite appropriate antibiotics before prostatic biopsies.
Trial Registration:
NCT02140502.
Insights
Transrectal prostate biopsies can lead to infections. Identifying patients with rectal E. coli resistant to ciprofloxacin (CIP) using the ECOFF cutoff can predict post-biopsy infectious complications, even with antibiotic prophylaxis.
Area of Science:
- Infectious Diseases
- Urology
- Microbiology
Background:
- Transrectal prostate biopsies are associated with a risk of post-procedural infections.
- Current antibiotic prophylaxis protocols may not fully prevent these complications.
- The role of rectal Escherichia coli (E. coli) susceptibility to ciprofloxacin (CIP) in predicting these infections is under investigation.
Purpose of the Study:
- To analyze the association between ciprofloxacin (CIP) minimal inhibitory concentration (MIC) of rectal E. coli and post-biopsy infectious complications.
- To compare the predictive value of EUCAST clinical breakpoints versus epidemiological cutoff (ECOFF) for CIP resistance in rectal E. coli.
Main Methods:
- A pre-biopsy rectal swab was obtained from 207 men undergoing transrectal prostate biopsy with CIP prophylaxis.
- Rectal E. coli CIP MIC was determined using chromogenic agar.
- E. coli isolates were categorized as sensitive or resistant based on EUCAST breakpoints and ECOFF criteria.
Main Results:
- A significant association was found between rectal E. coli CIP resistance (using both EUCAST and ECOFF criteria) and infectious complications.
- The ECOFF criteria (MIC > 0.064 mg/l) identified a higher proportion of patients with resistant E. coli (19.8%) compared to EUCAST breakpoints (8.7%).
- Patients carrying rectal E. coli with moderately lowered CIP susceptibility (MIC > ECOFF 0.064 mg/l) exhibited a substantially higher risk of developing infectious symptoms post-biopsy (OR 10.7).
Conclusions:
- Rectal E. coli with moderately lowered ciprofloxacin susceptibility, as defined by ECOFF, is a significant risk factor for infectious complications after transrectal prostate biopsies.
- This finding helps explain why some patients develop infections despite appropriate antibiotic prophylaxis.
- Utilizing ECOFF criteria for rectal E. coli susceptibility testing may improve risk stratification and inform prophylaxis strategies.
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