MP48-01 PREVALENCE OF ANTIBIOTIC RESISTANCE IN FECAL FLORA BEFORE TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY AND CLINICAL IMPACT OF TARGETED ANTIBIOTIC PROPHYLAXIS

Abstract

INTRODUCTION AND OBJECTIVES: In this study, we aimed to evaluate the clinical impact of targeted antibiotic prophylaxis on the sepsis rate after transrectal ultrasound guided prostate biopsy. METHODS: Between September 2012 and January 2014, 300 patients were randomized to two groups, while the first group (Group 1, n1⁄4156) received routine ciprofloxacin prophylaxis, and the second group (Group 2, n1⁄4144) received targeted prophylactic antibiotic regime adequate to rectal swab culture results. Rectal swab cultures were taken two weeks before the procedure. After the procedure, patients were followed one month and told to apply hospital if they see any symptoms such as fever (>38 C), shivering, dysuria or fatigue. RESULTS: Prostate specific antigen (PSA), prostate volume, digital rectal examination findings, pathology results and comorbidity rates were similar between two groups (Table 1.). While in Group 1 four patients (2.6%) applied to our clinic due to signs of sepsis, no patients (0%) applied to our clinic in Group 2 (p1⁄4 0.124). When rectal swab culture results of Group 2 were evaluated, ESBL presence in 18 patients (12.5%), quinolone resistance in 26 patients (18%), both the presence ESBL and quinolone resistance in 15 patients (10.4%) were observed. TMP-SMX to 6 patients, Cefuroxime to 10 patients, gentamicin to 4 patients, meropenem to 4 patients, amikacin to 1 patient and amoxicillin to 1 patient were received for prophylactic regimen who had fluoroquinolone resistant bacteria or ESBL. There were no statistically significance between antibiotic resistance and urologic operations, urinary tract infections, prior catheterization history, presence of catheter during prostate biopsy and antibiotic usage history due to high level of PSA. CONCLUSIONS: In our study, it has also been detected that rates of ESBL presence and ciprofloxacin resistance in rectal flora were not negligible. On the other hand, with obtaining rectal swab culture prior transrectal prostate biopsies and the use of targeted prophylaxis before prostate biopsy it has been observed that sepsis rates were reduced but these results were statistically insignificant.