Infectious DiseasesPrevalence of ST131 Among Fluoroquinolone-resistant Escherichia coli Obtained From Rectal Swabs Before Transrectal Prostate Biopsy
Section snippets
Subjects
The present study population of men with pre-TPB FQ-R rectal E coli was identified during a previous screening study that assessed the prevalence of FQ-R E coli among pre-TPB patients.16 The clinical protocol, inclusion and exclusion criteria, and patient characteristics were reported elsewhere.16 In brief, after Institutional Review Board approval at each institution and patient informed consent, rectal swabs were obtained from 136 men scheduled to undergo a TPB at 1 of 3 institutions (Long
Patient Characteristics and ST131 Status
Characteristics of the 27 men whose FQ-R pre-TPB rectal E coli isolates were available for analysis are reported in relation to ST131 colonization status in Table 1. The number of FQ-R isolates per subject per institution (% of present study population) was 13 (48%) for Long Beach Veterans Affairs Medical Center, 5 (19%) for Southern California Kaiser Permanente, and 9 (33%) for University of California Irvine Medical Center. There was no difference in whether a 1-day vs 3-day regimen was
Comment
The rectal reservoir is probably the “staging ground” for most urinary tract infections, including those that occur after TPB, in which context the biopsy needle provides rectal microorganisms with direct access to the urinary tract. Unfortunately, intestinal FQ-R E coli have been detected in the pre-TPB population at rates of 10% to 30%, which predictably would predispose TPB recipients to FQ-R E coli infections.6, 13, 16, 21 Indeed, despite fluoroquinolone prophylaxis, the overall post-TPB
Conclusions
Our study found 70% of 27 FQ-R fecal E coli isolates from men undergoing TPB in our locale represented the epidemic multidrug-resistant ST131 clonal group. Compared with non-ST131 isolates, the ST131 isolates exhibited highly distinctive aggregate virulence profiles, a significantly higher prevalence of 4 specific virulence genes (sat, usp, ompT, and malX), and a lower prevalence of cefazolin resistance and ESBL phenotype. ST131 was associated negatively with Asians and prebiopsy sodium
Acknowledgments
The manuscript is dedicated to Amy Nakama-Peeples, who performed most of the isolation and sensitivity analysis in the microbiology lab and tragically passed away; she will be missed dearly. Drs. Richard Szabo (Southern California Kaiser Permanente) and Atreya Dash (Long Beach Veterans Affairs Medical Center and University of California-Irvine Medical Center) helped obtain Institutional Review Board approval and participated in initial patient enrollment at the respective institutions.
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Cited by (29)
Molecular genetic testing does not improve the detection of fluoroquinolone resistance before transrectal prostate biopsy
2022, Prostate InternationalCitation Excerpt :One alternate approach is to use next-generation sequencing to identify quinolone resistance (PCR Screen). Our group identified a strain of E. coli (sequence type 131) as a causal source in more than 70% of the infections that occur post-TPB.13,14 Plasmids are another mechanism bacteria used to share genetic information to survive antibiotic exposures but have not been thoroughly evaluated.15
Trends in Antibiotic Resistance in Urologic Practice
2016, European Urology FocusCitation Excerpt :ST131 accounted for 40% of all E. coli bloodstream isolates after TRUPB [76]. Another study reported that 70% of fluoroquinolone-resistant E. coli isolated from rectal swabs taken from men before prostate biopsy belonged to ST131 [88]. The strong association between fluoroquinolones and ESBL production [89] has major implications in the setting of postbiopsy sepsis when considering prophylactic agents before TRUPB.
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This material is partly based on work supported by the Office of Research and Development, Medical Research Service, Department of Veterans Affairs, grant #I01 CX000192 01 (J.R.J.). Hardy Diagnostics provided the quality-controlled culture media, and Copan Diagnostics provided the culture swabs.