Prevalence of ciprofloxacin-resistant E.

Coli in
the intestinal flora of patients undergoing transrectal prostate biopsy in Dartford, UK.
Abstract
AIM:
To determine the efficacy of fluoroquinolone prophylaxis in patients undergoing trans-rectal ultrasound
scan (TRUS)-guided biopsy of the prostate among the patients in Dartford area, prevalence of
ciprofloxacin resistance in the faecal flora and usefulness of a pre-biopsy rectal screen in relation to
post biopsy infectious complications.

PATIENTS AND METHODS:

A prospective study was performed from May 2013 to November 2014, collecting the data including
rectal swab culture results of all patients (n=100) undergoing TRUS guided Prostate biopsy, with a
post-biopsy follow-up period of 2 to 8 months. All patients undergoing TRUS biopsies were given
prophylactic oral ciprofloxacin, as per Trust policy (500 mg 12 and one hour pre-biopsy, followed by
another 500 mg 12 hour post biopsy.
RESULTS:
Between May 2013 and November 2014, 100 patients were recruited after informed written consent
for this study, who required TRUS biopsy to rule out Prostatic malignancy. 94 of these patients
underwent TRUS and three Template biopsies, the latter had Gentamicin as prophylaxis; two patients
refused, one did not attend for biopsy. Among these, 4 were admitted to hospital for post-biopsy
sepsis, but of these two had E. Coli borderline resistance; one each had post-biopsy urinary retention
and UTI; only 4 (< 4%) had ciprofloxacin-resistant Escherichia coli confirmed from Rectal swab
cultures performed pre-biopsy: four had borderline/ suspected E. Coli. Patients who were admitted to
hospital, three of them had positive Blood cultures; all of them were treated with intravenous
antibiotics, namely Amikacin, IV Ciprofloxacin, IV Gentamicin, IV Temociliin, oral Doxycycline with
Ciprofloxacin for three to six days;--- of them were admitted in to Intensive Care Unit; five patients had
post-biopsy MSU with two of them positive for E. Coli.

CONCLUSION:
Ciprofloxacin-resistant E. Coli remains rare in the intestinal flora of Dartford population, therefore,
Ciprofloxacin remains adequate prophylaxis against post TRUS biopsy infections. Our current
antibiotic policy can be continued without performing pre-TRUS rectal swab cultures. It might be
helpful in cases of increasing age, people with history of recent travel to developing country, prior
fluoroquinolone use, in an area known to have high fluoroquinolone resistance to guide antibiotic
following post-biopsy sepsis and also to validate antibiotic policy of a particular hospital through an
audit.

KEYWORDS:
Prostate biopsy; infection; sepsis; fluoroquinolone; rectal swabs; Ciprofloxacin resistance.