在前列腺活检之前长期使用氟喹诺酮类药物可能增加耐药性微生物所致脓毒症的风险

Objectives:

To evaluate the effect of long-term fluoroquinolone treatment before the biopsy in terms of post procedure sepsis. Three-week fluoroquinolone management before the biopsy may lower serum prostate specific antigen (PSA) levels and prevent unnecessary biopsies.

Methods:

A total of 558 patients were referred to our clinic for transrectal ultrasound (TRUS)–guided prostate biopsy. Of the patients, 205 had received levofloxacin 500mg once a day for 3weeks before the biopsy to lower the serum PSA levels (group 1). A total of 353 patients had not received any antibiotics before the procedure (group 2). In terms of the postbiopsy sepsis rate, group 1 and group 2 as well as patients who underwent biopsies in the early period and the latter period of the study were compared.

Results:

Sepsis was diagnosed in 17 patients (3.0%) after biopsy. Of these patients, 11 (5.4%) and 6 (1.7%) were in group 1 and group 2, respectively (P=.0297, OR: 3.28, 95% CI: 1.10-10.13). Sepsis was diagnosed in 7 patients (1.9%) and 10 patients (5.0%) in the early and the latter period of the study, respectively (P=.0771, OR: 0.38, 95% CI: .13-1.09). Escherichia coli was the causative agent in all patients with a positive culture. In addition, 1 patient also had meticillinresistant Staphylococcus epidermidis (MRSE). All of the E. coli isolates were resistant to fluoroquinolones, and 55.6% were positive for extended spectrum β-lactamases (ESBL).

Conclusions:

Long-term fluoroquinolone use to prevent unnecessary prostate biopsy may result in postbiopsy sepsis caused by fluoroquinolone resistant microorganisms.