1179. Incidence of Bacteremia and Bacteriuria With Antibiotic-Resistant Enterobacteriaceae After Transrectal Ultrasound-Guided Biopsy of the Prostate (TRUSBP)

Abstract

BackgroundInfection with Escherichia coli after TRUSBP is common, but other Enterobacteriaceae also occur. In the absence of microbiological data, prophylaxis with co-trimoxazole (TMP-SMX) or fluoroquinolones (FQ) is usually prescribed. We estimated the incidence of bacteremia and bacteriuria after TRUSBP with distinct species of Enterobacteriaceae and their rate of resistance to common antibiotics.MethodsUsing Veterans Healthcare Administration (VHA) databases, we identified patients undergoing TRUSBP between January 1, 2013 and December 31, 2017. We determined the incidence of Enterobacteriaceae isolated from urine and blood cultures obtained within 30 days of TRUSBP. Using microbiology data from VHA, we determined rates of resistance to TMP-SMX, FQ (ciprofloxacin as marker), ESC (ceftriaxone as marker), and carbapenems (Carb) (ertapenem as marker).ResultsOverall, 377 (0.3%) and 1,739 (1.4%) of 126,761 TRUSBPs were complicated by bacteremia or bacteriuria with Enterobacteriaceae, respectively. E. coli was predominant (91% of blood and 81% in urine). Rates of FQ resistance were low in Klebsiellaand Enterobacter but exceeded 60% in E. coli. In general, TMP-SMX resistance exceeded 30%. Of note, 16.6% of blood and 11% of urine Enterobacteriacaea were resistant to ESC, while Carb-resistance was rare.ConclusionFQ and ESC-resistant Enterobacteriaceae are prevalent in bacteremia and bacteriuria after TRUSBP. Antibiotics used for prophylaxis and empirical treatment are likely to be ineffective. The prevention and management of TRUSBP-related infections should include microbiology-guided approaches.TotalESC-ResistantCarb-ResistantFQ ResistantTMP-SMX Resistant Enterobacteriaceae Blood3776116.4%20.5%23562.3%12934.2%Urine173919211.0%201.2%98656.7%60734.9%CitrobacterBlood31%0–1–1–Urine22522.7%29.1%836.4%731.8%EnterobacterBlood40000Urine46817.4%24.3%36.5%12.2% Escherichia coli Blood3445716.6%00.0%23267.4%12335.8%Urine141515711.1%20.1%93466.0%55639.3% Klebsiella Blood24312.5%14.2%28.3%416.7%Urine196147.1%63.1%157.7%2211.2% Morganella Blood21101Urine13215.4%538.5%538.5%861.5%Proteus33618.2%39.1%1751.5%1133.3%Providencia200–1–0–Serratia110021Shigella10011Disclosures All authors: No reported disclosures.